Local thyroid tissue ablation by high-intensity focused ultrasound: Effects on thyroid function and first human feasibility study with hot and cold thyroid nodules

Objective: The aim of this study was to assess whether high-intensity focused ultrasound (HIFU), a new and promising method for the treatment of benign hot and cold thyroid nodules using thermal ablation, has an impact on thyroid function, and to evaluate its feasibility in outpatient settings. Additionally, a possible difference in the treatment of solid and complex thyroid nodules was evaluated. Method: Ten patients with one thyroid nodule each (six cold and four hot nodules) underwent HIFU in January 2014. Four nodules were solid and six nodules were complex. Serum levels of triiodothyronine (T3), thyroxine (T4), thyrotropin (TSH), thyroglobulin (hTg) and additionally antibodies against hTg (TAK), TSH receptors (TRAK) and thyroid peroxidase (TPO) were measured at enrolment and 24?h after the HIFU treatment. The pre- and post-thyroglobulin reduction was measured to evaluate the scale of ablation. In addition, patients’ pain was recorded on a numeric rating scale from 0 to 10. Results: The HIFU treatment did not affect thyroid function, since hormone levels stayed stable (p?p?p?Conclusion: HIFU is a safe and effective method to treat benign, solid, complex, hot and cold thyroid nodules preserving thyroid function. Further developments of the system are needed to gain suitability for daily use.     

Conventional Ultrasonography and Real Time UltrasoundElastography in the Differential Diagnosis of DegeneratingCystic Thyroid Nodules Mimicking Malignancy and PapillaryThyroid Carcinomas

Background: To evaluate the diagnostic utility of conventional ultrasonography and real time ultrasoundelastography in differentiating degenerating cystic thyroid nodules mimicking malignancy from papillarythyroid carcinoma. Methods: We retrospectively analyzed conventional ultrasonographic and elastographiccharacteristics of 19 degenerating cystic thyroid nodules mimicking malignancy in 19 patients, with 30 surgicallyconfirmed PTCs as controls. Based on size, the nodules had been grouped into less than 10mm (group A) andgreater than 10 mm (group B). We evaluated conventional parameters and elasticity pattern. Color-scaledelastograms were graded as to stiffness of nodules using an elasticity pattern from I (soft) to IV (stiff). Results:Degenerating cystic thyroid nodules were similar to PTCs in conventional ultrasonographic findings, but theformer frequently showed oval to round in shape (group A, 69.2% vs 18.8%, P=0.017; group B, 66.7% vs7.14%, P=0.017) and punctuate hyperechoic foci (group A, 61.5% vs 0, P<0.001; group B, 50% vs 0, P<0.001).On real time ultrasound elastography, 7 of 13 degenerating cystic thyroid nodules in group A were pattern I,5 were pattern II, 1 was pattern III. One degenerating cystic thyroid nodule in group B was pattern II, 5 werepattern III. The area under the curve for elastography was 0.98 in group A (sensitivity 92.3%, specificity 100%,P = 0.002), and 0.88 in group B (sensitivity 16.7%, specificity 100%, P = 0.014). Conclusions: As a dependableimaging technique, elastography helps increase the performance in differential diagnosis of degenerating cysticthyroid nodule and malignancy.     

超声检查联合基质金属蛋白酶检测对甲状腺癌的诊断价值

目的：探讨超声检查联合基质金属蛋白酶（MMPs）检测诊断甲状腺癌的临床价值。方法：我院收治的476例甲状腺结节患者为研究对象,其中甲状腺癌63例,良性结节者413例。分别对两组患者进行超声弹性成像检查和基质金属蛋白酶检测。观察两组患者的超声表现,对两组患者的血清 MMP －2、MMP －9水平进行比较,并对超声检查以及超声联合基质金属蛋白酶检测两种检查方式在诊断甲状腺癌上的准确度、敏感度及特异度进行对比性分析。结果：从超声结果来看,无包膜、低回声、微钙化和囊性变在鉴别甲状腺良恶性结节上存在显著性差异（P ＜0．05）。甲状腺癌患者的弹性图像上多表现为3～4分,而良性结节组患者的评分多在0～2分,组间差异比较有统计学意义（P ＜0．05）。甲状腺癌组的 MMP －2、MMP －9水平均显著高于良性结节组,组间比较有显著性差异（P ＜0．05）。在鉴别甲状腺良恶性结节上,超声联合基质金属蛋白酶诊断甲状腺癌的阳性率和诊断良性结节的阴性率均明显高于超声诊断（P ＜0．05）。而超声联合基质金属蛋白酶诊断甲状腺癌上的准确度、敏感度和特异度分别为85．50％、90．48％、84．75％,均优于超声诊断（73．32％、76．19％、72．88％）,差异有统计学意义（P ＜0．05）。结论：超声弹性成像对于鉴别甲状腺癌具有一定临床价值,而基质金属蛋白酶在甲状腺癌的侵袭转移过程中发挥较为重要的作用,其过度表达能够作为甲状腺癌患者的预后指标,通过超声弹性成像联合基质金属蛋白酶检测能够显著提高甲状腺癌的诊断准确性。     

平消胶囊治疗良性甲状腺结节的临床疗效及对血清IL-1β与IL-6水平的影响北大核心

目的:探讨平消胶囊治疗良性甲状腺结节的临床疗效及其作用与血清白细胞介素-1β(interleukin-1β,IL-1β)与白细胞介素-6(interleukin-6,IL-6)水平的关系。方法:选取经细针穿刺细胞学病理为良性的100例甲状腺结节患者作为研究对象,随机分为治疗组与观察组各50例,同时招募甲状腺B超正常的健康人50例作为对照组。三组随访期间均食用无碘盐,忌海产品等富碘食物,治疗组加用平消胶囊,时间为6个月。比较治疗前后观察组与治疗组结节的大小和甲状腺相关激素水平;比较对照组、治疗组治疗前后血清IL-1β、IL-6的水平。结果:治疗后,观察组的结节直径较治疗前无统计学差异,治疗组的结节直径较治疗前减小(P<0.05)。观察组的有效率为12%,治疗组的有效率为70%,治疗组有效率高于观察组(P<0.05)。治疗后,观察组与治疗组的甲状腺相关激素的水平较治疗前无统计学差异(P>0.05)。治疗组患者的IL-1β水平高于对照组(P<0.05),IL-6水平低于对照组(P<0.05);治疗后,治疗组IL-1β和IL-6水平较治疗前提高(P<0.05);治疗后,治疗组IL-6水平与对照组相比无统计学差异(P>0.05)。结论:平消胶囊能减小良性甲状腺结节的直径,可能与调节IL-1β、IL-6的水平相关。     

术前血清促甲状腺激素水平与甲状腺结节相关性的研究

目的:探讨术前血清促甲状腺激素( TSH)水平与甲状腺结节良恶性的关系.方法:回顾性分析了1499例甲状腺结节手术切除患者术前血清TSH、甲状腺B超,手术记录、术后病理诊断报告.根据术后病理报告判定甲状腺结节良恶性,分析术前血清TSH水平在甲状腺良恶性结节中的不同分布.结果:分化型甲状腺癌(DTC)患者术前血清TSH水平明显高于甲状腺良性结节组(2.179 ±2.017vs1.259 ±0.884) μIU/ml,P＜0.001;在DTC患者中,有淋巴结转移较无淋巴结转移、TNM分期Ⅲ、Ⅳ期较Ⅰ、Ⅱ期以及肿瘤直径≥1cm较＜1cm的患者术前血清TSH明显升高(均P＜0.001).结论:术前血清TSH水平是预测甲状腺结节良恶性的重要指标.     

The Role of Vitamin D,Platelet-Derived Growth Factor and Insulin-Like Growth Factor 1 in the Progression of Thyroid Diseases

Background: Thyroid cancer (TC) is a common malignant tumor, however the role of total vitamin D: 25(OH)D, Platelet Derived Growth Factor (PDGF) and Insulin Like Growth Factor 1 (IGF-1) in the development of TC is still unclear. Aim: To assess the roles of 25(OH)D, PDGF and IGF-1 in the progression of thyroid diseases. METHODS: The serum levels of 25(OH)D, PDGF and IGF-1 were assessed in 70 patients with papillary thyroid cancer (PTC), 60 patients with benign thyroid nodules (BN) compared to 60 normal controls (NC) using ELISA technique. Results: There was a significant decrease in the serum level of 25(OH)D in TC patients compared to NC (P<0.001) and BN patients (P=0.006). There was a significant increase in the serum levels of PDGF and IGF-1 in TC patients (P<0.001), and BN patients (P<0.001) compared to NC, while there were no significant differences between TC and BN (P=0.087, and 0.258; respectively). PDGF correlated significantly with IGF-1 (r=0.412, P<0.001), TSH (r=0.146, P=0.045), and inversely correlated with 25(OH)D (r= -0.156, P=0.013) and FT4 (r=-0.178, P=0.014). There was a significant inverse correlation between the serum levels of IGF-1 and FT4 (r=-0.172, P=0.017). Sensitivity and specificity for assessment of TC patients were (65.7% and 58.3%, P= 0.001) for 25(OH)D, (65.7% and 58.3%, P=0.021) for IGF-1, and (68.6% and 61.7%, P=0.006) for PDGF. Multivariate analysis demonstrated that serum 25(OH)D (OR=0.578, 95%CI= 0.426-0.783), IGF-1 (OR=1.019, 95%CI= 1.010-1.029) and PDGF (OR=1.007, 95%CI= 1.004-1.009) were considered independent risk factors for thyroid cancer (P<0.001, for all). Conclusion: 25(OH) D, IGF-1 and PDGF are significantly different in TC and BN cases compared to control. They have an important role in the progression of TC. However, these data should be validated on a larger sample size.     

Bipolar radiofrequency ablation of benign thyroid nodules using a multiple overlapping shot technique in a 3-month follow-up

Purpose The aim of this study was to evaluate the decrease of benign thyroid nodules after bipolar radiofrequency ablation (RFA) in a 3-month follow-up using a multiple overlapping shot technique (‘MOST’).

Methods A total of 18 patients with 20 symptomatic benign thyroid nodules (17 cold nodules, 3 hyperfunctioning nodules) were treated in one single session by bipolar RFA. Bipolar ablation was performed using MOST. The nodule volumes were measured prior to ablation and 3 months after the procedure using ultrasound. The population consisted of either solid (>80% solid tissue within the volume of interest), complex, or cystic nodules (<20% solid tissue within the volume of interest).

Results Bipolar RFA resulted in a highly significant (p?<?0.0001) decrease of nodule volume (ΔV), median 5.3?mL (range 0.13–43.1?mL), corresponding to a relative reduction in mean of 56?±?17.9%. Median initial volume was 8?mL (range 0.48–62?mL); 3 months after ablation a median volume of 2.3?mL (range 0.3–32?mL) was measured. Nodule growth ≥50% occurred in 70% (14 nodules). At the follow-up no complications such as infections, persisting pain, nerve injuries or immunogen stimulation occurred. Patients with cold nodules (15) remained euthyroid, with hyperfunctioning nodules either euthyroid (2) or latent hypofunctional (1).

Conclusion The use of bipolar RFA is an effective, safe and suitable thermoablative technique to treat benign thyroid nodules. Combined with the multiple overlapping shot technique it allows sufficient ablation.     

高频超声对甲状腺囊实性结节良恶性鉴别的效果

目的 探讨高频超声对甲状腺囊实性结节良恶性鉴别的效果.方法 选取甲状腺囊实性恶性结节患者47例以及甲状腺囊实性良性结节患者47例.所有患者均予以高频超声检查,观察对比良、恶性结节图像特征.结果 高频超声诊断恶性结节的误诊率为8.51％(4/47),高于病理诊断的0.00％(0/47),差异有统计学意义(P<0.05).良性结节高频超声的病灶内部结构、内部回声、边界、形状、钙化与恶性结节对比,差异有统计学意义(P均<0.05).良性结节RI值<0.7人数占比为85.11％(40/47),高于恶性结节的14.89％(7/47),差异有统计学意义(P<0.05).结论 高频超声诊断甲状腺囊实性良性结节的准确度高,有利于鉴别甲状腺囊实性结节良恶性.     

Nodule size as predictive factor of efficacy of radiofrequency ablation in treating autonomously functioning thyroid nodules

Context: No defined pre-treatment factors are able to predict the response to radiofrequency ablation (RFA) of an autonomously functioning thyroid nodule (AFTN).

Objective: Primary endpoint was to evaluate the success rate of RFA to restore euthyroidism in a cohort of adult patients with small solitary AFTN compared with medium-sized nodules. Secondary endpoints included nodule volume reduction and rate of conversion from hot nodules to cold using scintiscan.

Methods: This was a 24-month prospective monocentric open parallel-group trial. Twenty-nine patients with AFTN were divided into two groups based on thyroid volume: 15 patients with small nodules (<12?mL) in group A and 14 patients with medium nodules (>12?mL) in group B. All patients underwent a single session of RFA and were clinically, biochemically, and morphologically evaluated at baseline and at 1, 6, 12 and 24 months after treatment.

Results: After RFA, there was greater nodule volume reduction in group A compared with group B (p?p?=?0.01), 12 (p?=?0.005), and 24?months (p?p?p?Conclusions: A single session of RFA was effective in restoring euthyroidism in patients with small AFTNs. Nodule volume seems to be a significant predictive factor of the efficacy of RFA in treating AFTN.     

低剂量螺旋CT联合肿瘤标志物CEA,SCC-Ag,ProGRP,NSE对良恶性孤立性肺结节的鉴别诊断价值

目的探讨低剂量螺旋CT联合肿瘤标志物癌胚抗原(CEA),鳞状上皮细胞癌相关抗原(SCC-Ag),胃泌素释放肽前体(ProGRP),神经特异性烯醇化酶(NSE)对良恶性孤立性肺结节的鉴别诊断价值。方法回顾性分析孤立性肺结节患者420例的临床资料,患者均有完整的低剂量螺旋CT及肿瘤标志物CEA、SCC-Ag、ProGRP、NSE检查结果和病理结果,以病理结果为金标准确定结节性质,比较良、恶性孤立性肺结节患者的低剂量螺旋CT的结节显示情况及肿瘤标志物CEA、SCC-Ag、ProGRP、NSE水平,比较低剂量螺旋CT和肿瘤标志物CEA、SCC-Ag、ProGRP、NSE单独检查及联合检查对良、恶性孤立性肺结节的检出率。结果病理结果提示420例孤立性肺结节患者中,良性287例,恶性133例。低剂量螺旋CT检查显示:良、恶性患者的结节直径、类型、结节形态、结节与肺的交界面、结节的边缘特征比较,差异均有统计学意义(P<0.05)。肿瘤标志物检查显示良性患者的血清CEA、SCC-Ag、ProGRP、NSE水平均显著低于恶性患者(P<0.05)。低剂量螺旋CT和肿瘤标志物联合检查对良、恶性孤立性肺结节的检出率均显著高于单独检查(P<0.05)。结论低剂量螺旋CT联合肿瘤标志物CEA、SCC-Ag、ProGRP、NSE对良恶性孤立性肺结节检出率高,并且对良、恶性结节具有鉴别诊断价值,可以为临床诊治工作提供指导信息。     

Factors related to recurrence of the benign non-functioning thyroid nodules after percutaneous microwave ablation

Purpose: To determine the factors affecting the recurrence of the solitary benign thyroid nodules (BTN) after microwave ablation (MWA).

Materials and methods: Between January 2013 and January 2015, a total of 110 patients with at least one solid thyroid nodule (solid component ≥?80%) were enrolled. MWA was performed under continuous ultrasound (US) guidance. Before and during the follow-up, the thyroid nodule volume, thyroid function and cosmetic complaints were evaluated. Recurrence is defined by the new blood flow in the total ablation area or/and >?50% increase in nodule volume.

Results: Almost all thyroid nodules were significantly decreased in size after MWA. After 12 months, the average volume of thyroid nodules was decreased from 12.6?±?15.1 to 3.2?±?5.7?ml. Of the total 110 patients, 16 cases had recurrence 12 months after MWA, and these patients had a larger initial volume than that of the non-recurrence patients (11.6?±?14.9 vs. 23.9?±?12.5, p?p?p?p?Conclusions: The US-guided MWA results in a satisfactory long-term outcome of the patients with a benign solitary thyroid nodule. We identified three risk factors for recurrence: initial volume, vascularity and the energy per 1?ml reduction in nodular volume.     

Pulmonary malignant focal ground-glass opacity nodules and solid nodules of 3cm or less: comparison of multi-detector CT features

Introduction: To evaluate the different multi‐detector computed tomography (MDCT) features between pulmonary malignant focal ground‐glass opacity (fGGO) nodules and solid nodules of 3 cm or less in diameter. Methods: One hundred and five malignant solid nodules and 48 malignant fGGOs confirmed by pathology were retrospectively analysed with regard to the patient's demographic data, nodule size and MDCT features (shape, margin, interface, internal characteristics and adjacent structure). Differences were analysed using the Fisher exact test or Mann–Whitney U‐test. Results: The male to female ratio of patients with malignant solid nodules (60:45) was higher than that with malignant fGGOs (18:30) (P < 0.05). There was no significant difference in either patient's age (P > 0.05) or nodule size (P > 0.05). The frequency of irregular shape (4% vs. 21%), spiculation (57% vs. 40%), vacuole sign (11% vs. 52%) and natural air bronchograms (0% vs. 24%) was significantly different between malignant solid nodules and fGGOs. No differences were found in the frequency of lobulation, cusp angle, spine‐like process, interface and adjacent structure between the two groups (P > 0.05). Conclusion: Malignant fGGOs and solid nodules showed mostly similar MDCT features. For malignant fGGOs, the frequency of irregular shape, vacuole sign and natural air bronchograms was higher than that in solid nodules, but the frequency of spiculation was lower than that in solid nodules.     

血清促甲状腺素水平与甲状腺癌发病的相关性

目的 观察血清促甲状腺素(TSH)水平与甲状腺癌发病的关系.方法 回顾性分析330例(恶性99例,良性231例)行甲状腺手术的甲状腺疾病患者的血清TSH水平、性别、年龄、肿瘤类型、结节个数,并探讨其与甲状腺癌发生之间的关系.结果 在年龄＜20岁和≥70岁的患者中,甲状腺癌所占的比例分别为63.0％和58.3％,明显高于60 ～ 69岁组(23.3％,均P＜0.05).在81例男性患者中,甲状腺癌所占的比例为43.2％,明显高于女性患者(25.7％,P=0.003).在112例单结节患者中,甲状腺癌所占的比例为42.0％,明显高于多结节患者(23.9％,P＜0.001).在TSH＜ 0.28mIU/L组和≥4.20 mIU/L组患者中,甲状腺癌所占的比例分别为54.6％和50.0％,均明显高于0.28～1.44 mIU/L组(16.1％,均P＜0.05);在正常TSH范围内,甲状腺癌所占与的比例随TSH水平的升高而升高(P ＜0.001).血清TSH水平高(OR=1.465,P=0.014)、男性(OR=1.964,P=0.016)以及单个甲状腺结节( OR=2.090,P=0.006)均为发生甲状腺癌的独立危险因素.结论 血清TSH水平高、男性、单个甲状腺结节者患甲状腺癌的风险高.     

超声造影参数对甲状腺癌的鉴别及其病情进展的评估价值

目的 探讨超声造影参数对甲状腺癌的鉴别及其病情进展的评估价值.方法 选取63例甲状腺癌患者及40例甲状腺腺瘤患者分别作为研究组及对照组,分析2组二维超声及超声造影相关参数差异等.结果 研究组PI、TTP、MTT水平较对照组明显更低(P<0.05).研究组PDCD4及PP4R1基因表达水平低于对照组,而ADAM9、TPX...     

奥沙利铂+替吉奥对进展期胃癌患者近期疗效及血清CTC、IGF-1、MMP-9水平的影响

目的探讨奥沙利铂+替吉奥对进展期胃癌患者近期疗效及血清循环肿瘤细胞(CTC)、胰岛素样生长因子-1(IGF-1)、基质金属蛋白酶-9(MMP-9)水平的影响。方法将进展期胃癌患者102例随机分为研究组与对照组,各51例,对照组给予替吉奥治疗,研究组给予奥沙利铂+替吉奥治疗,观察比较两组治疗后的临床疗效,检测两组治疗前后血清肿瘤标志物[糖类抗原50(CA50)、糖类抗原125(CA125)]、血清CTC、MMP-9、血管内皮生长因子(VEGF)、IGF-1水平,记录两组治疗期间不良反应的发生情况。结果经治疗后,研究组疾病总控制率明显高于对照组(P<0.05),血清CA50、CA125、CTC、MMP-9、VEGF、IGF-1水平均明显低于对照组(P<0.05)。两组治疗期间不良反应无明显差异(P>0.05)。结论奥沙利铂+替吉奥能提高进展期胃癌患者近期疗效,抑制肿瘤增生,降低肿瘤侵袭力,且不会明显增加不良反应,具有较高的用药安全性。     

Risk Factors Associated with Thyroid Carcinoma in North Pakistan

Background: Epidemiological data on thyroid cancer and associated risk factors are scarce in our setting. The present study was therefore designed to gather data which could be helpful in providing insights to thyroid physicians and surgeons for better management of affected patients. Purpose: To determine the frequency of carcinoma thyroid among patients presenting with goiter and its association with TSH, Tg/ATg and other demographic factors. Materials and Methods: A total of 73 adult patients of either gender with solitary solid cold nodules and/or multi-ndoular goiter (MNG) with predominant solid cold nodules were enrolled. All surgically resected samples were sent for histopathology. The frequency of thyroid cancer and its subtypes was noted and tested for association with gender, age (< or ≥40 years), recent increase in swelling size, TSH, Tg and ATg. Results: Thyroid cancer was diagnosed in 26% (n=19) of the patients, 14 (73.7%) being diagnosed with papillary thyroid cancer and 5 (26.3%) with follicular thyroid cancer. No other subtypes were noted. Presence of thyroid cancer was significantly associated with recent increase in swelling size and higher TSH Values mean TSH values (P<0.05). No significant association was found with gender, age, Tg and ATg values (P>0.05). Conclusions: Overall percentage of thyroid cancer in our study sample was found to be 26%, with a predominance of papillary over follicular lesions. Rates were significantly higher in patients who had history of recent increase in swelling size and higher and higher pre-surgery TSH values.     

胰岛素对化疗药物5-氟尿嘧啶的增效作用及其机制

目的建立裸鼠人食管癌模型,观察胰岛素是否增强5-氟尿嘧啶(5-Fu)对裸鼠的化疗疗效并探讨其机制。方法免疫组织化学方法检测肿瘤组织中CyclinD1的表达。ELISA方法检测裸鼠血清中胰岛素样生长因子(IGF-1)和胰岛素样生长因子结合蛋3(IGFBP-3)含量变化。结果大中小剂量胰岛素(0.09、0.06、0.03u/20g)均可明显增强5-Fu的抑瘤作用(P<0.05),但并不增加5-Fu的毒副反应。胰岛素组与对照组相比,CyclinD1表达水平明显增多(P<0.05)。5-Fu组和联合用药组之间IGF-I和IGFBP-3水平差异无统计学意义(P>0.05)。结论在裸鼠人食管癌模型中,胰岛素能增强5-Fu对裸鼠人食管癌移植瘤的化疗疗效,CyclinD1表达水平增多在胰岛素增效机制中发挥着重要作用。而血清中IGF-I和IGFBP-3含量变化尚不能解释其增效机制。     

What is the Role of Diffusion Weigh Magnetic Resonance Imaging in Evaluation of Thyroid Nodules?

This study aimed to compare ultrasonography (US), contrast-enhanced computed tomography (CCT) of the neck, and diffusion-weigh magnetic resonance imaging (DW-MRI) in differentiating between benign and malignant nodules while approaching to thyroid nodules, and to estimate sensitivity and specificity of these methods. On thyroid US, echogenicity, calcification, presence/absence of halo, nodule size being larger/smaller than 20 mm, and nodule nature (cystic/solid nature) were evaluated. Findings on CCT of the neck were grouped according to the heterogeneity/homogeneity, presence/absence of enhancement, and intensity. On DW-MRI, diffusion restriction was evaluated. The findings of these tests were compared with postoperative histopathological findings, and specificity and sensitivity of the tests in differentiating malignant and benign nodules were assessed. The study included 38 patients (34 females, 4 males). The sensitivity and specificity of DW-MRI were 20 and 75 %, respectively. Presence of a >20 mm nodule in thyroid US had the highest sensitivity, whereas thyroid fine-needle aspiration biopsy (FNAB) had the highest specificity in detecting malignancy. The sensitivities and specificities of CCT of the neck and DW-MRI appeared relatively low. Evaluation of thyroid US findings together with thyroid FNAB findings provided high specificity and sensitivity and yielded better results than findings of CCT of the neck and DW-MRI.     

代谢综合征与分化型甲状腺癌的发生及严重程度的相关性

目的:分析代谢综合征及其组分与分化型甲状腺癌的发生及严重程度的相关性。方法:收集自2020年06月至2022年06月在我院因甲状腺结节行手术治疗，术后病理确诊为分化型甲状腺癌的285例患者以及病理确诊为良性甲状腺结节的138例患者的临床资料，根据病理结果，分为良性组138例和恶性组285例；根据是否合并代谢综合征，将恶性组患者分为甲癌组156例和甲癌合并代谢综合征组129例。结果:恶性组患者BMI平均数及代谢综合征占比明显高于良性组，恶性组年龄平均数低于良性组，且存在显著性差异（P＜0.05）；甲癌合并代谢综合征组患者较甲癌组体质量指数、血压、空腹血糖、甘油三酯、肿瘤直径≥1、肿瘤位于双侧甲状腺、肿瘤多灶均高（P＜0.05），高密度脂蛋白胆固醇水平低（P＜0.05）。结论:合并代谢综合征的甲状腺结节患者恶性可能性更高，且在肿瘤直径、肿瘤位置、癌灶数量方面较未合并代谢综合征者表现出更严重的倾向，提示代谢综合征可能是影响甲状腺恶性肿瘤严重程度的危险因素。     

Minimally-invasive treatments for benign thyroid nodules: a Delphi-based consensus statement from the Italian minimally-invasive treatments of the thyroid (MITT) group

Benign thyroid nodules are a common clinical occurrence and usually do not require treatment unless symptomatic. During the last years, ultrasound-guided minimally invasive treatments (MIT) gained an increasing role in the management of nodules causing local symptoms. In February 2018, the Italian MIT Thyroid Group was founded to create a permanent cooperation between Italian and international physicians dedicated to clinical research and assistance on MIT for thyroid nodules. The group drafted this list of statements based on literature review and consensus opinion of interdisciplinary experts to facilitate the diffusion and the appropriate use of MIT of thyroid nodules in clinical practice. (#1) Predominantly cystic/cystic symptomatic nodules should first undergo US-guided aspiration; ethanol injection should be performed if relapsing (level of evidence [LoE]: ethanol is superior to simple aspiration = 2); (#2) In symptomatic cystic nodules, thermal ablation is an option when symptoms persist after ethanol ablation (LoE = 4); (#3) Double cytological benignity confirmation is needed before thermal ablation (LoE = 2); (#4) Single cytological sample is adequate in ultrasound low risk (EU-TIRADS ≤3) and in autonomously functioning nodules (LoE = 2); (#5) Thermal ablation may be proposed as first-line treatment for solid, symptomatic, nonfunctioning, benign nodules (LoE = 2); (#6) Thermal ablation may be used for dominant lesions in nonfunctioning multinodular goiter in patients refusing/not eligible for surgery (LoE = 5); (#7) Clinical and ultrasound follow-up is appropriate after thermal ablation (LoE = 2); (#8) Nodule re-treatment can be considered when symptoms relapse or partially resolve (LoE = 2); (#9) In case of nodule regrowth, a new cytological assessment is suggested before second ablation (LoE = 5); (#10) Thermal ablation is an option for autonomously functioning nodules in patients refusing/not eligible for radioiodine or surgery (LoE = 2); (#11) Small autonomously functioning nodules can be treated with thermal ablation when thyroid tissue sparing is a priority and ≥80% nodule volume ablation is expected (LoE = 3).