甲状腺结节钙化在诊断甲状腺癌中的意义

目的探讨甲状腺结节钙化在诊断甲状腺癌中的意义。方法归纳分析32例不同性质结节钙化的声像图表现。结果所有患者术前超声钙化检出率为23.02(%32/139),良性疾病发生率为10.62%,恶性疾病发生率为76.92%,两者相比差异有显著性(P<0.01),良性疾病微钙化发生率为4.42%,恶性疾病微钙化发生率为65.38%,两者相比,差异有显著性(P<0.01)。结论甲状腺钙化是目前超声诊断甲状腺癌的特征性指标。     

超声检查甲状腺结节钙化与微钙化对甲状腺癌的价值探讨

目的：探讨超声检查甲状腺结节钙化与微钙化在诊断甲状腺癌中的应用价值。方法：回顾性分析我院2009年1月～2011年7月间收治的325例甲状腺结节患者的超声检查结果与病理资料。结果：325例甲状腺结节患者中,甲状腺癌104例,钙化率84.62%,甲状腺良性结节221例,钙化率35.29%,甲状腺癌患者钙化率明显高于良性结节患者,差异具有统计学意义（P〈0.05）;甲状腺癌患者甲状腺结节微钙化占钙化总数的50.96%明显高于良性结节微钙化率9.50%,差异具有统计学意义（P〈0.05）。结论：超声检查甲状腺结节钙化与微钙化对诊断甲状腺癌有重要的临床价值,甲状腺结节微钙化是甲状腺癌的特征性诊断标志,临床医生需高度警惕。     

甲状腺结节内钙化对甲状腺癌的诊断意义探讨

目的探讨甲状腺结节内钙化在甲状腺癌中的诊断意义。方法回顾性分析五华县人民医院在2004年7月至2009年12月期间收治的418例术前行B超检查诊断为结节性甲状腺肿伴钙化的患者的临床资料。结果 418例术前经超声检查为结节性甲状腺肿伴钙化的患者经术中术后病理确诊为甲状腺癌者有223例,占53.33%(223/418),其中乳头状癌179例,占甲状腺癌的80.27%;微小钙化在418例钙化中占64.59%(270/418),在乳头状癌中占73.74%(132/179);不同年龄组之间(≥45和<45)恶性钙化结节比例分别为39.25%、68.13%,差异有显著性意义(P<0.05)。结论术前B超检查能早期发现甲状腺钙化,其对于甲状腺癌的诊断具有重要意义。     

超声探讨甲状腺钙化性结节与甲状腺癌的关系

目的探讨甲状腺钙化对诊断甲状腺癌的意义。方法对比272例次全甲状腺结节术前彩色二维超声检查与术后病理诊断。结果所有患者术前钙化检出率为18．0％（49／272），钙化总发生率为19．5％（53／272），良性疾病发生率为13．0％，恶性疾病发生率为52．9％，二者相比差异有显著性（P〈0．01），良性疾病微钙化发生率为3．4％，恶性疾病微钙化发生率为38．6％，两者相比差异有显著性（P〈0．01），甲状腺癌的钙化的发生与年龄无关。结论甲状腺钙化结节特别是微钙化对甲状腺癌的诊断意义重大，是目前诊断甲状腺癌特异性最高的指标。     

超声诊断甲状腺结节钙化的研究

目的研究和探讨超声诊断甲状腺结节钙化表现及其临床意义。方法采用回顾性分析的方法,对我院进行术前超声检查的52例甲状腺结节患者病历资料进行相关研究,分析并总结所有患者的不同钙化特点。结果经超声检查发现,各病理类型中均有可能出现甲状腺结节钙化的情况,但恶性所占比例较大,与良性相比差异显著(P<0.05);且粗钙化多出现在甲状腺良性病变中,而微钙化则在恶性肿瘤中较为常见,二者相比差异具有统计学意义(P<0.01)。结论对甲状腺结节钙化情况应用超声进行诊断,能较好地实现临床甲状腺结节良恶性的判断,具有重要参考价值。     

超声声像图中甲状腺钙化与甲状腺癌的关系

目的 探讨甲状腺微钙化在超声诊断甲状腺癌中的意义.方法 彩色多普勒超声检查甲状腺结节563例,按声像图中钙化有无及大小分为三组:A组61例,微钙化,钙化直径≤2mm;B组50例,粗钙化,钙化直径＞2mm,C组452例,无钙化.分析超声诊断与甲状腺手术后或穿刺活检病理结果.结果 563例患者中,超声诊断甲状腺癌101例(A组60例、B组2例、C组39例),病理显示甲状腺癌115例(A组59例、B组4例、C组52例).超声钙化检出率与病理钙化检出率相仿(19.7％ vs.21.3％)(P＞0.05).病理显示,恶性疾病钙化发生率明显高于良性(56.5％ vs,11.6％)(P＜0.01),恶性疾病微钙化发生率明显高于良性(55.7％ vs.1.3％)(P＜0.01).结论 超声声像图中钙化在一定程度上有助于甲状腺结节良、恶性的诊断;微钙化可能是更具有诊断甲状腺癌的特异性指标.     

微钙化在甲状腺癌的高频声像图中的意义

目的：评估甲状腺癌高频声像图中的微钙化的意义。方法：对44例甲状腺癌高频声像图中进行回顾性分析。结果：44例甲状腺癌中检出钙化24例（54．5％），微钙化20例，粗钙化4例，有微钙化的甲状腺癌中15例为乳头状癌，结论：高频声像图中的微钙化是诊断甲状腺癌的一个特异性指标，也是甲状腺乳头状癌的一个特征性表现。     

微小钙化在甲状腺癌中的诊断价值

目的回顾分析微小钙化在甲状腺癌的超声特点,总结微小钙化在甲状腺癌的诊断价值。方法用高频探头对41例甲状腺癌患者进行超声检查。结果 41例甲状腺癌中,12例伴有细砂粒样钙化,5例弥漫细小砂粒钙化,4例密集细砂粒样钙化,2例细小钙化灶,2例细小强光点,2例结节性甲状腺肿囊性变伴有强光点,1例强光点伴弧形钙化,2例钙化伴有声影,2例无钙化;病理结果32例为乳头状癌,3例滤泡状癌,2例未分化癌,2例髓样癌,1例甲状腺转移癌,1例为甲状腺淋巴瘤。其中3例为甲状腺结节癌变,1例隐匿在甲状腺腺瘤包膜下,1例伴有桥本甲状腺炎,13例颈部淋巴结转移,3例淋巴结内见有细砂粒样钙化。结论重视甲状腺单发结节合并微小钙化的超声特点,提高微小钙化在甲状腺癌诊断中的价值。     

甲状腺结节内钙化的高频彩超诊断与分析

目的探讨甲状腺结节钙化在诊断甲状腺癌中的意义,提高对甲状腺结节良恶性的鉴别能力。方法对2008年5月至2009年12月问收治的75例甲状腺钙化结节进行术前超声检查,分析不同钙化的特点,并与术后的病理结果作对照。结果75例均经术后病理证实,其中,良性结节51例,包括结节性甲状腺肿伴问质纤维化、钙化,结节性甲状腺肿伴囊性变;恶性结节24例,包括乳头状癌,滤泡性癌,19例伴有结节内微钙化（占恶性结节的78．5％）。结论微钙化是超声诊断甲状腺癌特异性最高的指标之一。     

甲状腺钙化灶在甲状腺良恶性病变鉴别诊断中的价值

目的 探讨甲状腺钙化灶在甲状腺良恶性病变鉴别诊断中的价值.方法 运用高频超声(7.5～10 mHZ)对312例甲状腺病灶中钙化灶进行检查,根据甲状腺病灶内钙化灶形态,大小,位置以及回声性质诊断甲状腺病变性质.结果 高频超声检出甲状腺病灶出现钙化灶312例中,经手术病理证实250例为甲状腺癌,癌变率约80.12%.结论 高频超声对甲状腺钙化灶的检测在甲状腺良恶性病变鉴别诊断中有重要临床价值.     

彩色多普勒超声下甲状腺结节内钙化对良恶性鉴别的诊断价值

目的：探讨彩色多普勒超声检测甲状腺结节内钙化对良恶性结节的诊断价值。方法2013年11月－2016年5月在某院手术治疗的甲状腺结节患者357例,回顾性分析患者的一般资料、术前彩色超声资料及术后病理结果,分析钙化类型与甲状腺结节良恶性的关系,彩超检查甲状腺结节内钙化对甲状腺癌的灵敏度、特异度。结果在52例甲状腺癌中超声检测出43例结节内钙化,占总数的82．69％明显高于甲状腺良性疾病12．13％的钙化率（ P＜0．05）;且微钙化在甲状腺癌的检出率为71．15％明显高于甲状腺良性结节2．62％微钙化率（ P＜0．05）,环状钙化及粗钙化检出率对于甲状腺良恶性诊断无明显差异（ P＞0．05）;微钙化、环状钙化、粗钙化对甲状腺癌的敏感度分别为80．43％、25．00％、25．00％,特异度分别为97．10％、97．10％、92．73％。结论微钙化对于甲状腺癌的诊断具有较高的敏感度和特异度,可将彩超检查甲状腺结节内微钙化作为筛选甲状腺癌的特异度指标。     

甲状腺结节的超声诊断

目的回顾分析甲状腺结节的超声表现及鉴别诊断,以提高对甲状腺结节的超声诊断水平。方法对31例甲状腺结节患者行超声检查,对超声图像特征进行分析结果31例患者中,诊断为结节性甲状腺肿大17例,甲状腺腺瘤8例,甲状腺癌4例,亚甲炎2例。结论通过学习甲状腺结节的超声分析诊断及鉴别,可以提高对甲状腺结节的诊断水平。     

The therapeutic management of differentiated thyroid cancer

Background: The management of thyroid cancer is difficult because the tumors comprise a wide range of biologic behaviors, from small papillary thyroid microcarcinomas that pose little or no threat to survival for the patient, to anaplastic thyroid cancers that are arguably the most lethal tumor. Although it may be difficult initially to determine at which end of the prognostic spectrum a patient resides, one can ordinarily estimate a patient's risk for tumor recurrence and mortality based on a triad of features as simple as the patient's age at the time of diagnosis, the tumor stage at presentation, and its initial response to therapy. While staging systems are available to assist in the management process, all are inexact and leave wide gaps in the treatment plan for a given patient. This is largely because randomized controlled trials are lacking as a result of the low incidence and generally favorable prognosis of the disease. As a practical matter, it may sometimes be difficult to reassure a patient, given the generally favorable prognosis of this group of tumors, knowing that without adequate therapy some become unexpectedly aggressive and recur years after initial management. The treatment of these tumors rests on a fine balance of providing care that reflects the anticipated course of the disease without overtreating the patient or providing reassurance that is unfounded. Objective: To outline the treatment strategy for patients with differentiated thyroid cancer based on the available literature and to guide clinicians through a management algorithm utilizing patient and tumor characteristics. Methods: This review is limited to the treatment of patients with differentiated thyroid cancer – papillary and follicular thyroid cancer – and the standard therapy required for the majority of patients. Results/conclusion: The treatment of differentiated thyroid cancer requires a multidisciplinary approach, involving an experienced surgeon, radiologists and an endocrinologist. There are many unanswered questions in the management algorithm and ongoing research is needed to further define the best treatment strategy for patients with differentiated thyroid cancer.     

常规体检高频超声对甲状腺结节的检出和甲状腺癌的诊断价值

目的探讨常规体检高频超声对甲状腺结节的检出和甲状腺癌的临床诊断价值。方法分析15626例常规体检高频超声的甲状腺声像图特点,观察甲状腺的大小、回声、肿块病变范围、形态、纵横比、边界、内部回声,彩色血流情况,对可疑者追踪其手术病理结果。结果2011-2012年常规体检高频超声检出甲状腺结节6191例,检出率为39．62％．可疑甲状腺癌193例,占结节检出人数的3．12％;手术病理证实甲状腺癌182例,诊断准确率为94．3％。结论常规体检高频超声对甲状腺结节的检出、结节良恶性半定性或定判断具有重要的临床价值。     

甲状腺结节与甲状腺癌的临床评估和处理

成人甲状腺结节的发病率相当高,其中大多数为良性病变,无需特殊处理,而恶性病变占5%~15%,需要及时处理。鉴于良恶性甲状腺结节对患者生存质量的影响有显著差异,且临床处理方法不同,所以鉴别结节的良、恶性非常重要。一般可通过病史、体格检查、影像学、核素扫描、细针穿刺、实验室检查等几方面评估甲状腺结节性质。对于分化型甲状腺癌需采取手术、同位素、甲状腺激素抑制治疗等综合手段,预后良好。     

Efficacy of lenvatinib in treating thyroid cancer

Introduction: Radioiodine [RAI]-resistant advanced and progressive differentiated thyroid cancer [DTC], although rare, constitutes a real challenge as its prognosis is poor and available therapeutic options, until now, have been limited. Discovery of a crucial role of distinct tyrosine kinases in DTC pathogenesis opened up new options in systemic treatment. Lenvatinib is an oral potent multi kinase inhibitor [MKI] of different growth factor receptors including VEGFR1/Flt-1, VEGFR2/KDR, VEGFR3, FGFR1,2,3,4, PDGFR-β as well as RET and KIT signaling networks. Its activity against RAI-refractory DTC was demonstrated in clinical studies fulfilling evidence-based medicine [EBM] criteria. The drug showed acceptable tolerance and manageable toxicity.

Areas covered: published results of phase II and III studies and other reports evaluated the efficacy and safety of lenvatinib in DTC and in medullary thyroid carcinoma.

Expert opinion: Currently there are two different MKIs, lenvatinib and sorafenib, which have demonstrated effectiveness against RAI-refractory DTC. However, to date, the question of which drug should be chosen for first line treatment remains open. The other question: when to start the treatment seems to be no less important. Whether disease progression, even by RECIST, is enough to initiate a therapy or tumor burden also plays an important role? EBM study, to resolve these issues, is our task for the nearest future.     

Novel therapies for thyroid cancer

Introduction: New therapeutic options for both differentiated thyroid cancer (DTC) and medullary thyroid cancer (MTC) have opened up during the past few years, as the key role of tyrosine kinases in the pathogenesis of thyroid carcinoma has been proved. Recently, two tyrosine kinase inhibitors (TKIs) targeting VEGFR vandetanib (Caprelsa) and cabozantinib (Cometriq) have been approved for advanced MTC, whereas, sorafenib (Nexavar) has been accepted to treat late-stage of DTC. Their efficacy was demonstrated in Phase III studies, compared to placebo; each of them significantly prolonged the progression-free survival.

Areas covered: Common adverse reactions related to VEGFR blockade are hypertension, proteinuria, impaired wound healing, hemorrhage and thrombosis, and congestive heart failure. Fatigue, different gastrointestinal disturbances with diarrhea, appetite decrease and weight loss are observed in the majority of patients. Another frequent TKI side effect is thyroid-stimulating hormone increase secondary to inhibition of MCT8-dependent T3 and T4 uptake in pituitary.

Expert opinion: So far, no direct comparison of both treatment outcomes and toxicity between particular drugs has been carried out. The evidence-based medicine guidelines are necessary to precisely indicate what drug to use: more effective or less toxic and when to start the treatment.     

The discovery and development of vandetanib for the treatment of thyroid cancer

Introduction: Thyroid cancer represents over 90% of all endocrine malignancies, with medullary thyroid carcinoma (MTC) accounting for 5 – 9% of them. Patients with early-stage disease have a favorable prognosis, but once distant metastasis develops, survival drops to 50% or less. Although surgery remains effective for early-stage disease, patients with advanced disease pose a challenge as traditional therapies have not provided long-term benefits. Vandetanib, initially developed to target other receptors, demonstrated anti-rearranged during transfection (anti-RET) kinase activity. This led to preclinical studies followed by recent human clinical trials, culminating in its FDA approval in April 2011 for application in the treatment of symptomatic or progressive MTC in patients with surgically unresectable, locally advanced or metastatic disease.

Areas covered: The authors provide a review of the discovery strategy and preclinical development of vandetanib. The authors also provide some insight into the clinical development and the drug's post-launch situation.

Expert opinion: Vandetanib has been shown to improve progression-free survival in MTC patients, but its impact on overall survival is still inconclusive. Further data analysis will be needed to answer the question of whether it impacts overall survival in MTC. Despite its advancements, vandetanib still lacks durable efficacy, carries moderate toxicity and has issues with drug resistance over time, not to mention issues of cost. There is a significant need for additional research to discover and develop improved therapeutic strategies for this difficult disease.     

超声引导下甲状腺穿刺细胞学检查在诊断甲状腺良恶性结节中的价值探究

目的:探究超声引导下甲状腺穿刺细胞学检查在诊断甲状腺良恶性结节中的价值。方法:选择某院60例甲状腺结节患者作为研究对象,对其行常规超声、超声引导下甲状腺穿刺细胞学检查,对比两种检查方法对甲状腺良、恶性结节诊断的准确率。结果:超声引导下甲状腺穿刺细胞学检查对甲状腺良、恶性结节诊断的准确率均显著高于常规超声,具有统计学意义(P<0.05);超声引导下甲状腺穿刺细胞学检查对甲状腺良、恶性结节诊断的准确率与手术病理检查结果对比无显著差异,无统计学意义(P>0.05)。结论:超声引导下甲状腺穿刺细胞学检查在诊断甲状腺良恶性结节中的价值显著,值得临床应用和推广。