| Research purposes: 1.On the basis of the Clinic pathological featuresof papillary carcinoma in the thyroid gland,we aim to provide some reliable clinical evidences for clinical research and early diagnosis,clinical treatments and postoperative management strategies of patients with papillary thyroid carcinoma.2.We explored the clinical value in the diagnosis of papillary thyroid carcinoma through the analysis of the expression of CK19,Galectin-3,TPO and MC in papillary thyroid carcinoma.3.We explored the relationship between the expression and clinicopathological parameters of papillary thyroid carcinoma and its influence on prognosis by researching the expression of mutant BRAFV600 E gene protein in papillary thyroid carcinoma.Research methods: 1.The cases for the patients who initially underwent thyroidectomy and confirmed as thyroid papillary carcinoma in postoperative pathology were collected,those cases with incomplete tissues and clinical data were excluded,from January 1st,2013 to July 31 st,2019in the First Affiliate Hospital of Guangzhou Medical University.The patient's detailed personal information and clinical data were extracted,including: age,gender,height,weight,clinical manifestations,reasons for visiting the doctors,major imaging examinations and other clinical data.Combined with clinicopathological data,we conducted retrospective statistical analysis.2.139 samples of initial thyroidectomy in the First Affiliated Hospital of Guangzhou Medical University from January 1st,2013 to July 31 st,2019 were collected as observation group,the expression of CK19,Galectin-3,TPO and MC in papillary thyroid carcinoma were detected by immunohistochemistry.92 cases of benign lesions in simultaneous surgical treatmentwere collected as control group,the expression of these tumor markers in cancer tissues and benign lesions was compared and analyzed,the significance of its detection to the diagnosis and differential diagnosis of papillary thyroid carcinoma was analyzed.3.244 samples of initial thyroidectomy in the First Affiliated Hospital of Guangzhou Medical University from January 1st,2015 to December 31 st,2017 were collected.All the subjects clearly diagnosed with Immunohistochemical staining for CK19,galectin-3,TPO and/or MC,CD56.59 males and 185 females,aged 16-82 years old(average 42.62±13.87 years old);tumors with diameter of 0.05~7 cm(average 1.46±1.01 cm).Among them,189 cases were classic papillary thyroid carcinoma and 55 cases were follicular papillary thyroid carcinoma;another 40 cases of para-carcinoma tissue were selected as the control group.Immunohistochemistry was adopted to detect the expression of BRAFV600 E gene mutant protein in 244 cases of papillary thyroid carcinoma and para-carcinoma tissue.The relationship between BRAFV600 E mutation and clinical pathological parameters was analyzed in combination with clinicopathological data.Result: 1.Results from retrospective cases analysis 1.1 The patients with papillary thyroid carcinoma are increasing year by year.Duringthe 6 years from 2013 to 2019,the patients with papillary thyroid carcinoma increased year by year,slowly increased from 2013 to 2016,and rapidly increased to more than 100 cases after 2017 and 2018 with the growth rate exceeded 3 times within 6 years.The number of the patients with papillary thyroid carcinoma is increasing year by year.1.2 Age and gender distribution of papillary thyroid carcinoma The age range of male patients is 19-71 years old,with an average of 40.92±12.16 years old.The age range of female patients is 8-82 years old,with an average of 42.17±14.05 years old.The age of attack of males was higher than that of females.The average age of attack of males was slightly younger than that of females,and the difference was not statistically significant(P<0.05).The overall incidence peak occurred in the age group of 20 to 34 years old,the peak incidence of males was 35 to 44 years old,and the peak incidence of females was 20 to 34 years old.The peak incidence of females was higher than that of males(P<0.05).99 cases of male patients accounted for 24.03%,313 female patients accounted for 75.97%,the ratio male to female is 1:3.16,the difference between male and female patients in different age groups was not statistically significant(P<0.05);in different years,male and female disease composition was also not statistically significant(P<0.05),so we can say,the growth curves of male and female patients were roughly parallel.1.3 Main imaging findings The diagnosis of papillary thyroid carcinoma detected by ultrasound and CT was in poor agreement(P<0.05).The detection rate of papillary thyroid carcinoma was 73.12%,which was significantly higher than that of CT(51.61%).The difference was statistically significant(P<0.05).1.4 Histopathological ferture The papillary thyroid carcinoma is mainly composed of classic subtypes and follicular subtypes,319 cases and 92 cases respectively,and 1 case of wrap type.162 cases of small cancer(diameter ?1cm);273 cases of single focal type,139 cases of multifocal type(unilateral leaf multifocal or bilateral lobe multifocal),71 cases of capsule invasion(including striated muscle infiltration),15 cases of vascular invasion 120 cases of lymphatic metastasis,12 cases of striated muscle infiltration,1 case of invasion of bronchial wall,and 2 cases of distant metastasis(lung metastasis).Papillary thyroid microcarcinoma accounts for 39.32% and there was no significant difference in aggressive behavior between PTMC and non-PTMC(P(29)0.05).1.5 The relationship between the reasons forclinic visit and clinicopathological feature The reasons to visit doctor for papillary thyroid carcinoma:(1)physical examination or accidental discovery due to other diseases,(2)obvious signs or related symptoms.There were no significant differences between the two groups with different tumor diameters,different histological types,lymph node metastasized or not,capsule and vascular invaded or not,or multiple lesions or not(P(29)0.05).There were no significant differences in aggressive behavior between cases of incidental findings in physical examinations and those with clinically significant signs or symptoms.1.6 The relationship between lymph node metastasis and other clinicopathological features The lymphatic metastasis rate of papillary thyroid carcinoma was 53.57%.The lymphatic metastasis rate of patients with age less than 45 is higher than that in patients with age greater than or equal to 45;the lymphatic metastasis rate of male patients was higher than that of female patients;the lymphatic metastasis rate of multifocal patients was higher than that of single lesions;the rate of classical lymphatic metastasis was higher in different histological types.Among different histological types,the expression of classic lymphatic metastasis was higher than that of follicular type,and the above differences were statistically significant(P<0.05).The lymphatic metastasis rate of tumors with a diameter more than1 cm was slightly higher than that of tumors with a diameter less than or equal to1 cm.The lymphatic metastasis rate was higher in patients with PTC and capsules than in those without capsules.The lymphatic metastasis rate in PTC patients with vascular invasion was higher than that in patients without vascular invasion,but the difference was not statistically significant(P(29)0.05).2.The expression of CK19,Galectin-3,TPO and MC in papillary thyroid carcinoma The expression of CK19(+),Galectin-3(+),TPO(-)and MC(+)in PTC weresignificantly higher than those in benign lesions(P<0.05).CK19 has the highestsensitivity(100%)and the lowest specificity(43.48%)when tested with separateindicators.TPO has the highest specificity(93.48%)and the lowestsensitivity(73.38%).The combination of Galectin-3 and MC was the best,withhigh sensitivity and specificity in the double detection(92.81%,88.04%).Thecombination of CK19,Galectin-3 and MC was the best in the triple detection,andthe sensitivity and specificity were 92.81% and 88.04%,respectively;thespecificity was as high as 96.74% when combined with the four indicators,but thesensitivity and accuracy were only 68.34% and 79.65%.3.The clinical significance of BRAFV600 E mutant protein expression in PTC 3.1The expression of BRAFV600 E mutant protein in PTC andits relationship with clinicopathological feature BRAFV600 E mutant protein was expressed only in papillary thyroid carcinoma,the ratewas 86.48%,but did not express in paracancerous and non-tumor tissues.Itsexpression rate was 88.89% in classical papillary thyroid carcinoma and 85% inlymphatic metastasis group,94.64% in the violation group,was higher than thefollicular type(78.18%),the group without lymphatic metastasis(68.42%),andthe group without membrane invasion(84.04%).The difference was statisticallysignificant(P<0.05).But there was no significant difference in diameter of tumor,age,gender,and number of lesions(P(29)0.05).3.2The relationship between BRAFV600 E mutant and prognosis of PTC In this research,244 patients were followed up for 1 to 44 months.The medianfollow-up time was 18 months.There were 234 cases of disease-free survival,1case of recurrence,1 case of lymphatic metastasis,1 case of lung metastasis,2 cases of death and 5 cases were lost to follow-up.The patients with papillarythyroid carcinoma had favourable prognosis.There was no significant differencein the cumulative disease-free survival rate between the BRAFV600 E mutant proteinpositive group and the negative group(P(29)0.05).There was no significantdifference in the cumulative total survival rate(P(29)0.05).Conclusion: 1.The number of patients with papillary thyroid carcinoma in our hospital has been on the rise in recent years,and the proportion of microcarcinoma is larger.Pathological types were classical,and the lesions were mostly single.There are significant gender differences in papillary thyroid carcinoma patients,mainly in women.The peak age of onset is mainly young and middle-aged women should pay more attention to papillary thyroid carcinoma.2.The main screening method for papillarythyroid carcinoma is color Doppler ultrasonography,which is considered convenient and quick with no invasion or radioativity,thus it has good compliance in the crowd.It can accidentally detect cases with no obvious signs and symptoms,and its detection rate is also significantly higher than CT.Ultrasound is recommended for preoperative screening and postoperative monitoring.3.The reasons for clinic visit doctor of papillary thyroidcarcinoma were not significantly related to the progression of the lesion.It should be taken seriously regardless of the patient's treatments.4.Lymphatic metastasis is the main pathway of metastasis in papillary thyroid carcinoma.Male,aged 45 years old and classic subtype are independent risk factors for lymphatic metastasis.These factors should be taken clinically in determining whether to perform lymph node dissection and custom management.5.CK19,Galectin-3 and MC were highly expressed in PTC,and the expression was significantly higher than that of benign lesions.The expression of TPO in PTC was defective but high in benign lesions.Its detection was helpful for PTC and benign differential diagnosis between lesions.For special case diagnosis,joint testing can be adopted.6.BRAFV600 Emutant protein is associated with lymphatic metastasis,capsule invasion and classical subtypes,but has no relationship with age,gender,number of lesions,and vascular invasion.It is suggested that BRAFV600 E mutant protein positive can be used as a prognostic predictor of papillary thyroid carcinoma. |
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