术前甲状腺结节的良恶性鉴别——附1367例甲状腺结节临床资料分析

目的探讨临床特征及术前各种辅助检查在判断甲状腺结节良恶性方面的价值。方法对1999—2004年上海交通大学医学院附属瑞金医院1367例甲状腺结节手术患者的临床资料进行回顾性分析。结果1367例甲状腺结节中良性病变1141例(83.47%),恶性病变226例(16.53%)。辅助检查中,B超检查敏感度、特异度、诊断准确度分别为2.11%,99.27%,83.19%;CT检查分别为22.58%,86.00%,70.99%;细针穿刺(FNA)细胞学检查分别为65.12%,95.08%,82.69%。多因素回归分析结果显示,患者较年轻,存在实性、质地偏硬的结节,结节伴钙化或颈部无痛性淋巴结肿大者恶性可能性较大。结论临床症状、体征、甲状腺B超及FNA对恶性甲状腺病变均有一定的提示作用,尤其是FNA在判断结节性质方面具有较高的敏感度、特异度及诊断准确度。     

甲状腺结节良恶性的判断和处理

甲状腺结节是临床最常见的甲状腺疾病。据美国甲状腺协会调查,普通人群触诊检出的结节占4%～10%[1]。近年来随超声检查的普及,调查显示甲状腺结节的患病率已达18%～67%[1]。甲状腺结节在     

US-elastography in the differential diagnosis of benign and malignant thyroid nodules.

BACKGROUND: Ultrasound (US)-elastography is a newly developed imaging technique for the reconstruction of tissue stiffness by measuring the degree of tissue's deformation in response to the application of an external force. This technique has previously been shown to be useful in the differential diagnosis between benign and malignant tumors. METHODS: The objective of this study was to assess the diagnostic accuracy of US-elastography in the differential diagnosis of thyroid cancer, using the cytologic/histopathologic analysis as the reference standard. A total of 67 consecutive patients with thyroid nodules who were referred to the Thyroid Unit at the Policlinico MultiMedica were enrolled in this prospective study between January and December 2006. Eighty-six nodules in these patients were examined by US B-mode, US color-power-Doppler, and US-elastography. Nodules were subjected to fine-needle aspiration biopsy and patients with a reading of malignant or indeterminate had thyroid surgery. The final diagnosis was based on the cytology reading in those who did not have surgery and the histopathology reading in those who had surgery. US-elastography scores were based on four classes of tissue stiffness (class 1 for soft nodules; class 2 and 3 for nodules with an intermediate degree of stiffness; class 4 for anelastic lesions). RESULTS: Seventeen nodules were malignant and 69 were benign. Sensitivity and specificity of the US-elastography for thyroid cancer diagnosis were 94.1% (16/17) and 81% (56/69), respectively. The positive and negative predictive values were 55.2% (16/29) and 98.2% (56/57), respectively. The accuracy of the technique was 83.7%. CONCLUSION: US-elastography is a promising technique that, combined with other US modalities, is easy and rapid to perform and can help to identify thyroid nodules that are likely to be malignant. An important limitation is probably lack of sensitivity for follicular thyroid carcinoma.     

CD30 ligand is expressed on resting normal and malignant human B lymphocytes

CD30, a member of the tumour necrosis receptor superfamily, is physiologically expressed on a subpopulation of T helper cells in normal individuals but is also expressed on several malignant and virally transformed cells. Its ligand (CD30L) is a pleiotropic cellular transmembrane protein that can induce cell death in several CD30⁺ cell lines. CD30L expression has been reported on activated human peripheral blood T lymphocytes and macrophages but not on B cells. Here we show that the CD30L is expressed on resting normal and on malignant B cells in addition to both CD4⁺ and CD8⁺ subsets of activated T cells, making it the second tumour necrosis family member, in addition to the CD27 ligand, that can be expressed on both T and B cells. These findings raise the possibility that the CD30L has a role in B-cell/T-cell communication and that B and T cells are likely to be involved in the growth regulation of CD30⁺ tumours.     

鉴别甲状腺良恶性结节分子标记物的研究现状

甲状腺结节在临床上十分常见,大致可分为良性结节和甲状腺癌两类,其中良性结节占绝大部分,而甲状腺癌不到5%.不同类型的甲状腺结节性病变治疗原则各不相同,正确判断结节的性质对治疗方案的选择具有十分重要的指导意义.通过确定特异性分子标记物来鉴别甲状腺结节的良、恶性有望为临床处理提供一定的帮助.     

鉴别甲状腺良恶性结节分子标记物的研究现状

甲状腺结节在临床上十分常见,大致可分为良性结节和甲状腺癌两类,其中良性结节占绝大部分,而甲状腺癌不到5%.不同类型的甲状腺结节性病变治疗原则各不相同,正确判断结节的性质对治疗方案的选择具有十分重要的指导意义.通过确定特异性分子标记物来鉴别甲状腺结节的良、恶性有望为临床处理提供一定的帮助.     

鉴别甲状腺良恶性结节分子标记物的研究现状

甲状腺结节在临床上十分常见,大致可分为良性结节和甲状腺癌两类,其中良性结节占绝大部分,而甲状腺癌不到5%.不同类型的甲状腺结节性病变治疗原则各不相同,正确判断结节的性质对治疗方案的选择具有十分重要的指导意义.通过确定特异性分子标记物来鉴别甲状腺结节的良、恶性有望为临床处理提供一定的帮助.     

Co-expression of interleukin-6 (IL-6) and interleukin-6 receptor (IL-6R) in thyroid nodules is associated with co-expression of CD30 ligand/CD30 receptor

Data on the expression of interleukin 6 (IL-6)/interleukin 6 receptor (IL-6R) in thyroid nodules is scarce. Based on our recent data of CD30 ligand (CD30L)/CD30 receptor (CD30) in these nodules and on the knowledge that this signal stimulates IL-6 production in non-thyroid neoplasms, we wanted to evaluate the immunocytochemical expression of these 2 ligand/receptor systems in a large archival series of paraffin-embedded specimens. These specimens included 6 normal thyroids and 130 thyroid nodules. Co-expression of IL-6 and IL-6R in the epithelial (follicular) cells was observed solely in CD30L/CD30 positive nodules: 5/15 (33%) oncocytic adenomas; 6/30 (20%) follicular adenomas which belonged to 2 variants (4/4 microfollicular toxic and 2/2 hyalinizing trabecular); 9/30 (30%) papillary thyroid cancers (PTC), all belonging to the conventional variant. In PTC the proportion of tumor epithelial cells that were IL6 positive was inversely correlated with the pTNM staging (r=-0.549, p=0.01). All 15 follicular cancers (FTC), all 6 anaplastic cancers (ATC) were IL-6/lL-6R negative; 14/15 FTC and 5/6 ATC were CD30L/CD30 negative. In another oncocytic adenoma, another 4 conventional PTC and another 7 non-conventional PTC CD30L/CD30 expression was associated to expression of IL-6 only. IL-6 staining associated to absent expression of CD30L and CD30 was observed in 7 follicular adenomas (all belonging to variants different from toxic and hyalinizing trabecular), 2 oncocytic adenomas, 5 of the 30 colloid nodules and 2 normal thyroids. Of the 6 tumors arising from the parafollicular C cells (medullary thyroid cancer, MTC), all 3 that had metastasized were CD30L/CD30/IL-6 positive and IL-6R negative; only IL-6 expression was lost in both the local and distant metastases. This finding matched the loss of IL-6 expression in one PTC metastasis. All 3 non-metastasized MTC were IL-6/IL-6R negative, and 1/3 was CD30L positive/CD30 negative. We conclude that only in a subset of both benign and malignant thyroid nodules the IL-6/IL-6R signal could be induced by the CD30L/CD30. IL-6 expression is related with aggressiveness in both PTC and MTC. In the normal thyroid tissue, colloid nodules, and another subset of benign and malignant thyroid nodules, IL-6 expression is under control of signals other than CD30L/CD30.     

良性及恶性甲状腺肿瘤端粒酶活性的表达

甲状腺结节是甲状腺最常见的一种疾病 ,正确鉴别结节的性质 ,区分其为良性或恶性极为重要。现有的影像学 ,免疫学、细胞学诊断都存在一定的误诊率 ,迫切需要寻找一种灵敏度高、特异性强的方法。端粒酶是一种核糖核蛋白 (ｒｉｂｏｎｕｃｌｅｏｐｒｏｔｅｉｎ) ,在恶性肿瘤的发病过程中有非常重要的作用 ,人类大多数恶性肿瘤细胞具有端粒酶的高表达〔1〕。甲状腺恶性肿瘤端粒酶活性是否表达阳性 ?细针抽吸 (ｆｉｎｅ ｎｅｅｄｌｅａｓｐｉｒａｔｉｏｎ ,ＦＮＡ)细胞标本端粒酶活性测定是否能与组织测定结果一致 ?本研究对良性及恶性甲状腺肿瘤…     

术前血清促甲状腺素水平与甲状腺结节良恶性关系的研究

]调查了1 870例甲状腺手术患者的术前血清TSH、手术记录、术后组织病理报告等.发现分化型甲状腺癌患者的术前血清TSH明显高于良性甲状腺结节患者[(1.95±1.69对1.40±1.98)mIU/L,P＜0.01].在分化型甲状腺癌患者中,有淋巴结转移或肿瘤直径大于10 mm的患者较无淋巴结转移或肿瘤直径小于10 mm的患者术前血清TSH水平升高(均P＜0.01).提示术前血清TSH水平是预测分化型甲状腺癌风险的一个指标.     

Angiogenesis in benign and malignant thyroid disease.

CONTEXT: Angiogenesis has been recognized as an important process contributing to the pathophysiology of many benign and malignant diseases. It is not surprising, therefore, that this complex process is proving to be an important regulator of both benign and malignant disease processes in the thyroid gland. This paper will review the general principles of angiogenesis and lymphangiogenesis, as well as the importance of the balance between angiogenic stimulators and inhibitors in the normal thyroid gland. We will also review how this balance is disturbed in benign and malignant thyroid conditions. Finally, we will address the role manipulation of this process may play in the development of novel treatment strategies for diseases of the thyroid. OBJECTIVE: To review the literature concerning the role of angiogenesis in the thyroid gland. CONCLUSIONS: Angiogenesis is an important process which has been shown to be involved in the pathophysiology of benign and malignant diseases of the thyroid gland. Manipulation of this process holds great promise for the development of novel treatments for these disorders. As the mechanisms regulating angiogenesis in the thyroid become increasingly clear, researchers will come ever closer to turning this promise into clinical reality.     

Diagnostic value of ultrasonography to distinguish between benign and malignant lesions in the management of thyroid nodules.

OBJECTIVE: We analyzed the sonographic characteristics of thyroid nodules and assessed the diagnostic value of ultrasonography in order to distinguish between benign and malignant lesions in terms of the management of thyroid nodules. DESIGN: We retrospectively analyzed the sonographic features of thyroid nodules in 580 patients who had been examined with fine-needle aspiration cytology or who underwent surgery for a thyroid nodule. The sonographic features that suggested malignancy include microcalcifications, an irregular or microlobulated margin, marked hypoechogenicity, and a shape that was taller than it was wide. The presence of one or more of these features indicated classification as category 3 (malignant). The absence of all of these features indicated classification as category 2 (benign). Presence of an anechogenic cystic nodule was classified as category 1 (benign). MAIN OUTCOME: Of 124 lesions classified as category 3, 60 of the lesions were malignant. Of 418 lesions classified as category 1 or 2, 409 were benign. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy based on the sonographic classification method were 87.0%, 86.5%, 48.4%, 97.8%, and 86.5%, respectively. CONCLUSIONS: Our results identified this sonographic classification as a useful tool in the differentiation of malignant nodules from benign nodules. In view of the high negative predictive value of sonographic classification, a more aggressive approach is recommended only for category 3 nodules.     

Expression of vascular endothelial growth factor-C in benign and malignant thyroid tumors

In contrast to vascular endothelial growth factor (VEGF), which stimulates angiogenesis, VEGF-C is thought to stimulate lymphangiogenesis. The role of VEGF-C in thyroid cancer pathogenesis has not been clarified. One might expect a different pattern of VEGF-C expression in the various types of thyroid cancer because of their different means of metastases. In this investigation, we determined whether the differential expression of VEGF-C might explain the different propensity to lymph node metastasis in thyroid cancers. One hundred eleven normal and neoplastic thyroid tissues were analyzed by real-time quantitative PCR. Papillary thyroid cancers had a higher VEGF-C expression than other thyroid malignancies (P < 0.0005 ANOVA). Among the normal thyroid tissues from patients with malignant or benign thyroid diseases, there was no significant difference in VEGF-C expression. Paired comparison of VEGF-C expression between thyroid cancers and normal thyroid tissues from the same patients showed a significant increase of VEGF-C expression in papillary thyroid cancer (1.10 +/- 0.41 vs. 0.70 +/- 0.13; P = 0.001) and a significant decrease of VEGF-C expression in medullary thyroid cancer (0.11 +/- 0.13 vs. 0.78 +/- 0.29; P = 0.001). In contrast, there was no significant difference of VEGF-C expression between cancer and normal tissues in other types of thyroid cancer. In summary, VEGF-C expression is increased in papillary thyroid cancer, compared with paired normal thyroid tissues, but not in other thyroid cancers that are also prone to lymph node metastasis. The lymphangiogenic role of VEGF-C in thyroid cancers therefore appears to be complex and other factors are likely to be also involved.     

Prevalence of RET/PTC rearrangement in benign and malignant thyroid nodules and its clinical application

Fine-needle aspiration cytology (FNAC) is the primary means to distinguish benign thyroid nodules from malignant ones. About 20% of FNAC yields indeterminate results leading to unnecessary or delayed surgery. Many studies of tissue samples, the majority of which are retrospective advocate testing for RET rearrangements as a diagnostic adjunctive tool in thyroid nodules with indeterminate cytological findings. Because of the uncertain prevalence of RET rearrangements, its utility as a tumor marker is still controversial. The goal of this study was to establish the prevalence and the utility of testing for RET rearrangements in FNAC suspicious of cancer in a clinical setting. In this prospective study, we analysed a large series of thyroid aspirates by RT-PCR only and Southern blot on RT-PCR products for type 1 and 3 RET rearrangements. Results were compared with clinical findings, cytological diagnosis and final histopathology. By the higher sensitive Southern-blot on RT-PCR method, RET rearrangements were present in 36% of papillary thyroid carcinomas (RET/PTC-1, 12%; RET/PTC-3, 20%; both, 4%) and of 13.3% of benign nodules. By means of RT-PCR only, RET rearrangements were disclosed only in 14.3% of PTC and in 3.6% of benign nodules. No significant correlation was found between RET rearrangements and clinicopathological features of patients. These results indicate that molecular testing of thyroid nodules for RET/PTC must take into account of its high prevalence in benign nodules, inducing false positive diagnoses when the highly sensitive assay Southern-blot on RT-PCR is used. Its searching by means of RT-PCR only, has a specificity superior of conventional cytology and can be used to refine inconclusive FNAC.     

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甲状腺结节比较常见,其发病情况依赖于检查人群和检查方法的敏感性,通常认为在一般人群中的甲状腺结节患病率为10%,进行超声检查的诊断率为20%~60%,尸体解剖检出率为50.5%。甲状腺结节的发病率随年龄而增加,在儿童中的患病率为0.05%~1.80%,成人则上升到10%。女性多见,男女比可达1∶4。大多数的甲状腺结节是良性病变,恶性甲状腺结节大约在6%以下。只有对甲状腺结节进行规范化的诊断和治疗,才能避免误诊或过度治疗。甲状腺结节的诊断和处理原则是用最简便、准确而经济的方法明确诊断,早期治疗。因此,对于不同类型结节的诊断程序和处理原则是不…