Objective To investigate the value of CT signs in combination with clinical materials of papillary thyroid carcinoma (PTC) to predict the central lymph node metastasis (CLNM).Methods This article reviewed the CT signs and clinical materials of 366 patients with surgically and pathologically verified PTC.The single factor and multi-factor logistic regression analyses were performed on the relation of tumor position,thyroid marginal contact,calcification,plain scan border,border after enhancement,diameter,age and sex with CLNM.Results Among the 366 patients with PTC,the number of patients with positive CLNM and negative CLNM was 155 and 211 respectively.The single factor and multi-factor logistic regression analysis indicated that the thyroid marginal contact,diameter,age and sex were related with CLNM,and the more common patients diagnosed with CLNM had the following features:thyroid marginal contact,a diameter ＞1.0 cm,age ＜45 years and males (P＜ 0.05).Among the single risk factors,the tumor position,calcification,plain scan border and border after enhancement were unrelated with CLNM (P＞0.05).Conclusion The thyroid margin contact,diameter＞l.0 cm,age＜45 years and males are independent risk factors in diagnosis of positive CLNM.

Objective To analyze CT characteristics of patients with primary parathyroid hyperplasia ( PPH) , parathyroid adenoma ( PA) , atypical parathyroid adenoma ( APA) , and parathyroid carcinoma ( PC) and to evaluate the value of CT in the diagnosis and differential diagnosis of primary hyperparathyroidism ( PHPT ) . Methods CT scan of 134 pathologically proved PHPT patients with complete clinical and laboratory data were retrorespectively analyzed .The similarities and differences of CT features in patients with PPH , PA, APA and PC were studied.Results Among 140 lesions in the 134 patients, 130 cases had solitary parathyroid mass and 4 cases had 10 parathyroid masses , including 22 lesions in 17 patients with PPH, with the diameter ranging from 0.6 cm to 2.8 cm(1.2 ±0.6)cm, 106 lesions in 105 patients with PA, with the diameter ranging from 0.3 cm to 3.2 cm (1.1 ±0.6)cm, 10 lesions in 10 patients with APA, with the diameter ranging from 0.9 cm to 3.3 cm(2.6 ± 0.6)cm, and 2 lesions in 2 patients with PC, with the diameter ranging from 2.1 cm to 3.0 cm(2.6 ±0.6)cm. 124 lesions were located in tracheo-esophageal groove or at the side of trachea on CT .The boundaries between the parathyroid and thyroid gland were low density .3 lesions did not appear .9 lesions were located at the area over the manubrium sterni among 13 lesions which were ectopic.CT images showed round (29.9%,41/137), oval (38.0%,52/137), triangular(19.7%, 27/137), and cylindrical(12.4%,17/137) tumors in 137 lesions.The density of lesions were 30-66 Hu(45.0 ±12.3)Hu on non-enhanced CT scan, and 59-209 Hu(121.8 ±32.7)Hu on enhanced scan .Different pathological lesions had no statistical difference on location ( left upper , left lower , right upper, right lower, ectopic)(χ2 =15.839), linear low density sign(χ2 =1.896), shape(χ2 =10.945), non-enhanced CT(χ2 =0.915) or enhancement CT(χ2 =6.165)(P>0.05).Different pathological lesions had statistical significance on sizes(χ2 =18.395, P<0.05).The diameter of APA-PC was bigger than that in PH-PA.99 lesions exhibited homogeneous enhancement , and 38 lesions exhibited heterogeneous enhancement .The necrosis rate of APA-PC was more than that of PH-PA(χ2 =7.929, P<0.05).Conclusions The lesions origi-nate from parathyroid if they are located in tracheo-esophageal groove or at the side of trachea with hyperparathy-roidism.Multiple lesions help in PH diagnosis .Large size and necrosis in lesions imply APA or PC .The location (left upper, left lower, right upper, right lower, ectopic), shape, density and the degree of enhancement of the lesions have not specificity for diagnosis of PHPT .

Objective:To investigate the predictive value of the clinicopathological features of breast cancer for pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) and to establish a predictive model based on the clinicopathological features.Methods:Clinicopathological data collected from 182 patients who underwent NAC and surgical treatment in Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine from Jan. 2013 to Dec. 2019 were retrospectively analyzed. The univariate and multivariate analysis were used to analyze the relationship between clinicopathological features and pCR after neoadjuvant chemotherapy. The predictive value in predicting the efficacy of NAC was evaluated, the receiver operating characteristic (ROC) curve and Nomogram prediction model were constructed.Results:Multivariate Logistic regression analysis showed that progesterone receptor (PR) , human epidermal growth factor 2 (HER2) and platelet distribution width (PDW) were independent predictors of pCR after NAC for breast cancer. The area under the curve (AUC) of model for predicting efficacy of NAC was 0.810 (95% CI:0.745-0.864) and the sensitivity and specificity was 68.75% and 82.67% respectively when the Jordan Index is at its maximum. Conclusion:ER-, HER2+ and PDW≤13.4% show better efficacy of NAC. The Nomogram model based on them can accurately predict the efficacy of NAC and can provide a reference for the selection of treatment options in clinical diagnosis and treatment.

Objective To investigate the diagnostic value of hyperenhancement sign on ultrasound,CT and their combination in diagnosis of thyroid benign and malignant nodules.Methods The contrast-enhanced ultrasound and enhanced CT datas of 172 thyroid nodules in 144 cases confirmed by operation and pathology were retrospectively analyzed,including 97 benign nodules and 75 malignant nodules.According to the degree of enhancement,these nodules were divided into iso-or low-enhancement and hyperenhancement.The distributions of ultrasound hyperenhancement,CT hyperenhancement and both of them in thyroid benign and malignant nodules,adenomatoid lesions and nodular goiters were analyzed,followed byx2 test for statistical analysis.Results In 172 thyroid nodules,the proportions of ultrasound hyperenhancement,CT hyperenhancement and both of them in thyroid benign and malignant nodules were 53.6％(52/97) and 20.0％(15/75)(x2＝20.090,P＜0.05),34.0％ (33/97) and 4.0％ (3/75) (x2＝23.033,P＜0.05),31.0％ (30/97) and 0％ (0/75) (x2＝28.096,P＜0.05),respectively.Their sensitivity and specificity of diagnosing benign nodules were 53.6％ (52/97) and 80.0％ (60/75),34.0％ (33/97) and 96％ (72/75),30.9％ (30/97) and 100％ (75/75),respectively.The proportions of ultrasound hyperenhancement,CT hyperenhancement and both of them in adenomatoid lesions and nodular goiters were 96.9％(31/32) and 32.3％(21/65)0x2＝35.946,P＜0.05),65.6％(21/32) and 18.5％(12/65)(x2＝21.250,P＜0.05),65.6％(21/32) and 13.8％ (9/65)(x2＝26.912,P＜0.05).Their sensitivity and specificity of diagnosing adenomatoid lesions were 96.9％(31/32) and 67.7％(44/65),65.6％(21/32) and 81.5％(53/65),65.6％(21/32) and 87.2％(56/65).Conclusions Ultrasound hyperenhancement,CT hyperenhancement for diagnosing thyroid benign nodules are of significant value.Especially for adenomatoid nodules,ultrasound hyperenhancement has a higher sensitivity,while CT hyperenhancement has a higher specificity.Their combination can further improve the diagnostic specificity,thus reducing the unnecessary surgical trauma.

Central neck lymph node is the main site of metastasis of papillary thyroid cancer. However, the central area of dissection scope and integrity are still issues and controversies. The vast majority of papillary thyroid cancer in central lymph node dissection process, ignoring the lymph node posterior to fight recurrent laryngeal nerve (LN-prRLN), strictly speaking, does not do the central area of lymphatic adipose tissue intact, completely removed. This paper summarizes the recent literature on the LN-prRLN clinical dissection scope, the incidence of LN-prRLN transfer, LN-prRLN dissection impact on the incidence of complications, recurrence rate, mortality and survival rate were reviewed analysis, summarized the LN-prRLN dissection indications, clinical significance and importance.
Carcinoma ; surgery ; Carcinoma, Papillary ; Humans ; Incidence ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Metastasis ; Neck ; Neoplasm Recurrence, Local ; Recurrent Laryngeal Nerve ; surgery ; Survival Rate ; Thyroid Neoplasms ; surgery

Objective To explore the expression of papillary thyroid carcinoma (PTC)-specific microRNAs in order to improve early diagnosis of PTC's and determine the invasiveness of PTC.Methods Thyroid samples from 51 cases were analyzed to investigate microRNA expression differences between benign and malignant thyroid nodules by using miRNA chip technique.The differences in the expression of microRNAs were validated by qRT-PCR,and their correlation with clinical and pathological features of PTC was analyzed.Results (1) qRT-PCR analysis showed that miR-30a-3p (U =60,P =0.003),miR-146b-5p(U =40,P =0.001) and miR-199b-5p (U =69,P =0.007) significantly different between benign and malignant tissues.(2) Expression of miR-199b-5p was significantly higher in PTC patients with margin invasion and of ipsilateral neck lymph node metastasis(P =0.010).Conclusions miR-199b-5p,miR-30a-3p and miR-146b-5p may be used to differentiate benign and malignant thyroid nodules; miR-199b-5p can help assess the invasiveness of PTC.

Objective To investigate the application value of combined detection of serum human epididymis protein 4 (HE4),cancer antigen 125 (CA125) and cancer antigen 19-9 (CA 19-9) in early endometrial carcinoma.Methods Two hundred and six patients with early endometrial carcinoma (endometrial carcinoma group) and 118 patients with uterine fibroids (uterine fibroids group) were selected.Serum level of HE4 was measured by enzyme linked immunosorbent assay (ELISA),and serum levels of CA 125 and CA 19-9 were measured by chemiluminescence immunoassay(CLIA).The positive rates of serum HE4,CA125 and CA19-9 in the 2 groups were compared.The changes between pre-and post-operative in the serum levels of serum HE4,CA125 and CA19-9 were compared in 147 endometrial carcinoma patients.Results The serum levels of HE4 and CA19-9 in endometrial carcinoma group were significantly higher than those in uterine fibroids group [76.57 (56.92-104.60) pmol/L vs.56.75 (48.33-68.91) pmol/L,13.26(6.07-25.90) kU/L vs.7.64(3.76-16.45) kU/L],there were statistical differences (P =0.000),there was no statistical difference in serum level of CA125 between the 2 groups (P=0.106).In endometrial carcinoma group,the positive rates of serum HE4 and HE4 + CA125 + CA19-9 were significantly higher than the positive rates of serum CA125,CA19-9,CA125+CA19-9,there were statistical differences (P ＜ 0.01).The positive rates of serum HE4,CA19-9,HE4 +CA125,HE4 +CA19-9 and HE4 +CA125 +CA19-9 in endometrial carcinoma group were significantly higher than those in uterine fibroids group,there were statistical differences (P ＜ 0.01).The serum levels of HE4,CA125 and CA19-9 in post-operative in 147 endometrial carcinoma patients were significantly lower than those in pre-operative,there were statistical differences (P ＜ 0.01).Conclusion The diagnostic value of serum HE4 in early endometrial carcinoma is better than CA125 and CA19-9,while combined detection of serum HE4,CA125 and CA19-9 can raise the positive rate and be helpful for therapeutic effect evaluation.

Preoperative serum specimens were collected from 249 endometrial cancers and 99 uterine leiomyomas and their concentrations of human epididymis protein 4 (HE4),CA 125 and CA 19-9 were detected.The indices of diagnostic evaluation were calculated.Preoperative serum concentrations of HE4,CA125 and CA19-9 in endometrial carcinoma group were significantly higher than those of control group.The areas under curve of HE4,CA125 and CA19-9 were 0.736,0.615 and 0.661 respectively and that of combiued markers was 0.774.At a 90％ specificity,the sensitivities for HE4,CA125,CA19-9 were 55.0％,26.9％ and 30.1％ while that of combined markers was 56.2％.HE4 is an ideal tumor marker for endometrial cancer and combined detection improves diagnostic rate.

Objective To discuss the predictive value of multiple ultrasonic features combination in diagnosis of thyroid papillary carcinoma (PTC) more than 1.0 cm in diameter. Methods The ultrasonic features of 258 PTC nodules from 251 patients and 207 nodular goiter (NG) nodules from 190 patients in the First People′s Hospital of Hangzhou were retrospectively analyzed. All the nodules were confirmed by pathological examination after surgery. The ultrasonic features included the shape of nodules, internal echo,anteroposterior/transverse diameter ratio (A/T), and microcalcification. The χ2 test was used to analyze the differences of ultrasonic features between PTC and NG. Multi-variate analyses (Logistic regression) was used to analyze the predictive risk ultrasonic features of PTC. The sensitivity and specificity of ultrasonic features were analyzed based on the gold standard of pathological results. Results There were significantly differences between 258 PTC nodules and 207 NG nodules in irregular shape, hypoechogenicity,A/T > 1 and microcalcification (χ2 values were 121.511, 105.411, 41.483, 121.072, all P < 0.01). The results of Logistic regression showed that irregular shape, hypoechogenicity, A/T>1 and microcalcification were risk ultrasonic features of PTC. And their OR values were 5.013 (95%CI 2.919-8.610), 5.811 (95%CI 3.411-9.901), 15.399 (95%CI 7.576-31.301), 4.141 (95%CI 1.687-10.164) respectively. The sensitivity and specificity of single ultrasonic feature were 26.0%-79.5% and 71.5%-96.1%; the sensitivity and specificity of two ultrasonographic features combination were 11.2%-57.0% and 92.3%-99.0%; and the sensitivity and specificity of three or four ultrasonographic features combination were 8.1%-31.8% and 99.0%-99.5%.Conclusions Irregular shape, hypoechogenicity, A/T> 1 and microcalcification of thyroid neoplasm are important ultrasonic features of PTC. Although the sensitivity of single ultrasonic feature in diagnosing PTC is higher than that of multiple features combination, it has a lower specificity. Therefore, combination of multiple ultrasonographic features can improve the specificity in diagnosing PTC and reduce the misdiagnosis of PTC.

Objective To investigate the expression of miR-199b-5p in papillary thyroid carcinoma ( PTC) and its relationship with clinical features .Methods Total RNA was extracted from 36 cases of PTC and the adjacent normal thyroid tissues by reverse transcription quantitative real-time polymerase chain reaction ( qRT-PCR)method to detect the expression of miR-199b-5p, and to analyze its relationship with clinical features such as the capsule invasion and lymph node metastasis .Results miR-199b-5p expression in PTC was related to lymph node status(χ2 =9.20, P=0.01), capsule invasion(U=36.00, P=0.047), but had no correlation with other clinical characteristics such as age , sex, tumor size, the number of tumor foci ( U =151.00, 87.00, 64.00, 87.00 respectively, P>0.05).ROC curve analysis showed that the specificity and sensitivity of miR-199b-5p in diagnosis of PTC were 82.1% and 72.7% respectively.Conclusion The abnormal expression of miR-199b-5p may be related to the occurrence , development and invasion of PTC .