COX-2、VEGF和E-cad在乳腺癌组织中的表达及临床病理意义

目的：探讨环氧化酶-2（COX-2）、血管内皮生长因子（VEGF）和E-钙黏附蛋白（E-cad）在乳腺癌组织中的表达及与临床病理特征之间的关系。方法：应用免疫组化S-P法检测30例乳腺单纯性增生、30例乳腺导管内癌、70例乳腺浸润性导管癌组织中COX-2、VEGF和E-cad的表达情况。结果：COX-2在乳腺单纯性增生、乳腺导管内癌、乳腺浸润性导管癌组织中的表达率分别为10.0%、46.6%、72.8%,乳腺单纯性增生与乳腺导管内癌、乳腺浸润性导管癌差异均有统计学意义（P〈0.01）;乳腺导管内癌与乳腺浸润性导管癌差异有统计学意义（P〈0.05）。VEGF在乳腺单纯性增生、乳腺导管内癌、乳腺浸润性导管癌组织中的表达率分别为3.3%、50.0%、65.7%,乳腺单纯性增生与乳腺导管内癌、乳腺浸润性导管癌相比差异均有统计学意义（P〈0.01）;乳腺导管内癌与乳腺浸润性导管癌差异无统计学意义（P〉0.05）。E-cad在乳腺单纯性增生、乳腺导管内癌、乳腺浸润性导管癌组织中的表达率分别为93.3%、43.30%、32.8%,乳腺单纯性增生与乳腺导管内癌、乳腺浸润性导管癌差异均有统计学意义（P〈0.01）;乳腺导管内癌与乳腺浸润性导管癌差异无统计学意义（P〉0.05）。COX-2在乳腺浸润性导管癌的阳性表达与淋巴结转移有关（P〈0.05）,与年龄、肿瘤大小、组织学分级无关（P〉0.05）。VEGF、E-cad在乳腺浸润性导管癌的阳性表达与组织学分级、淋巴结转移密切相关,与年龄、肿瘤大小无关。COX-2、VEGF在乳腺浸润性导管癌中的表达呈正相关（R=0.44,P〈0.01）,COX-2在乳腺浸润性导管癌中的表达与E-cad的表达呈负相关（R=-0.26,P〈0.05）。结论：COX-2、VEGF的高表达及E-cad的低表达在乳腺癌的发生发展过程中起重要的作用,检测其表达异常对判断临床进展、推测预后以及制定针对性的治疗方案有一定的参考价值。     

乳腺浸润性导管癌病灶与腋窝转移淋巴结中ER和HER-2表达的关系

目的：探讨雌激素受体（ER）和人表皮生长因子受体（HER-2）在人乳腺浸润性导管癌肿瘤病灶与腋窝转移淋巴结中表达的关系。 方法：检测80例乳腺癌肿瘤病灶和转移淋巴结中ER（免疫组化法）和HER-2（荧光原位杂交法）的表达情况,并分析两者相关性与一致性。 结果：80例患者中,乳腺癌肿瘤病灶ER阳性34例（42.50%）,HER-2阳性26例（32.50%）;腋窝淋巴结转移灶ER阳性37例（46.25%）,HER-2阳性27例（33.75%）,两者在肿瘤病灶与腋窝淋巴结的阳性率差异均无统计学意义（P=0.750,P=1.000）。肿瘤病灶与腋窝转移淋巴结ER均阳性32例,HER-2均阳性22例,肿瘤病灶与腋窝转移淋巴结两种受体表达情况总符合率为83.75%,两者在原发灶与腋窝淋巴结转移灶的表达具有较好的相关性和一致性（r=0.825,0.746;κ=0.823,0.764）。 结论：人乳腺浸润性导管癌肿瘤病灶与腋窝转移淋巴结中ER和HER-2表达具有较好的相关性与一致性。     

CD24在乳腺浸润性导管癌中的表达及临床意义

目的:研究CD24在乳腺浸润性导管癌组织不同模式中的表达及其与临床病理因素的相关性。方法:用SP免疫组化染色法检测13例乳腺纤维腺瘤及46例乳腺浸润性导管癌组织中CD24的表达。结果: 浸润性乳腺导管癌组织中CD24在细胞膜和细胞浆都有表达，阳性率为80.43%；乳腺纤维腺瘤CD24仅在细胞膜上局灶性表达，阳性率为53.85%。CD24在浸润性导管癌中的表达浓度明显高于纤维腺瘤(P＜0.05)；并与腋窝淋巴结转移正相关(P＜0.05)；CD24细胞膜表达与雌、孕激素受体阳性表达密切相关(P＜0.001)，而与患者年龄、肿瘤大小、肿瘤分期、分级、Her 2及p53等因素无相关性（P＞0.05）。结论:CD24高表达参与乳腺癌的侵袭与转移，CD24细胞膜表达可能与乳腺癌内分泌治疗抵抗作用相关，CD24可作为乳腺不良预后的判断指标之一。     

端粒酶逆转录酶、环氧化酶-2在乳腺癌中的表达及其意义

目的 探讨端粒酶逆转录酶(hTERT)和环氧化酶(cox)-2在乳腺浸润性导管癌中的表达及其临床意义.方法 使用免疫组织化学法分别检测45例乳腺浸润性导管癌和22例乳腺良性病变标本的hTERT和COX-2蛋白表达情况.结果 hTERT在乳腺浸润性导管癌中阳性表达率fig71.11%,明显高于乳腺良性病变9.09%,两者比较差异有统计学意义(P<0.05).hTERT阳性表达与乳腺浸润性导管癌患者的年龄、肿瘤大小、腋窝淋巴结转移情况及雌、孕激素表达水平无相关性(P>0.05),与Her-2表达存在显著相关性(P<0.05).COX-2在乳腺浸润性导管癌中的阳性表达率为82.22%,明显高于乳腺良性病变50.00%,两者比较差异有统计学意义(P<0.05).COX-2阳性表达与乳腺浸润性导管癌患者腋窝淋巴结转移情况、Her-2、ER阳性表达有关(P<0.05).在乳腺浸润性导管癌中hTERT阳性表达与COX-2阳性表达呈正相关(r=0.557,P<0.01).结论 hTERT与COX-2在乳腺浸润性导管癌中的表达显著高于在乳腺良性病变中的表达,hTERT与COX-2在乳腺癌的发生、发展中起重要作用.hTERT表达与COX-2表达存在显著相关性,COX-2的过度表达可能是端粒酶激活和调节的机制之一.     

乳腺浸润性导管癌中survivin与NF-κB的表达及其临床意义

背景与目的：肿瘤的侵袭和转移是乳腺癌死亡的主要原因,对乳腺癌分子标记物的研究有助于诊断和预后判断,乳腺癌组织中凋亡基因survivin和核转录因子NF-κB蛋白的关系尚不清楚,本研究探讨乳腺浸润性导管癌组织中survivin和NF-κB蛋白的表达及其与患者临床病理特征、分子亚型及预后的关系,以期拓展对乳腺癌发病机制的理解与认识,为乳腺癌防治提供新策略。 方法：选择2015年5月—2017年5月在郑州人民医院行手术治疗、术后经病理确诊且病历完整的80例乳腺浸润性导管癌患者作为研究对象,用免疫组化法检测患者癌组织与癌旁组织在survivin与NF-κB蛋白的表达,用统计学方法分析survivin、NF-κB蛋白与患者临床病理参数、分子亚型及预后的关系。 结果：survivin与NF-κB在乳腺浸润性导管癌组织中的阳性表达率均明显高于癌旁组织（53.75% vs. 11.25%;56.25% vs. 8.75%,均P<0.05）。survivin和NF-κB的表达均与组织学分化、淋巴结转移状况、TNM分期、分子分型有关,均表现为在低分化、淋巴结转移阳性、TNM分期晚、非luminal型乳腺癌组织中高表达（均P<0.05）;同时,两者共高表达率也在低分化、淋巴结转移阳性、TNM分期晚、非luminal型的乳腺癌组织明显升高（均P<0.05）。乳腺浸润性导管癌组织中survivin和NF-κB表达呈正相关（r=0.546,P=0.000）。生存分析结果显示,survivin或NF-κB高表达患者的5年无病生存率均低于各自的低表达患者,而两者共高表达的患者5年无病生存率低于两者任何单一高表达或两者共低表达患者（均P<0.05）。Cox回归分析显示,NF-κB、survivin与NF-κB共表达、肿物直径、分化程度和淋巴结转移是乳腺浸润性导管癌患者预后的独立危险因素（均P<0.05）。 结论：乳腺浸润性导管癌组织中survivin和NF-κB蛋白的表达与患者的恶性临床病理特征及不良预后密切相关,而且两者可能存在协同作用促进了乳腺癌的发生与发展。     

乳腺浸润性导管癌CK5、CK8及P63蛋白表达及临床意义

目的探讨乳腺癌细胞角蛋白（CK5、CK8）及P63蛋白表达规律及临床意义。方法采用免疫组化SP法检测CK5、CK8及P63在96例乳腺浸润性导管癌中的表达,并分析其与临床病理特征的关系。结果CK5在乳腺浸润性导管癌中表达较弱,仅有17例（17.7%）呈现阳性表达;CK8在乳腺浸润性导管癌中表达较高,89例（92.7%）呈现阳性。77例（80.2%）乳腺浸润性导管癌呈现CK5^-/CK8^＋表型,5例（5.2%）呈现CK5^＋/CK8^-表型,12例（12.5%）呈现CK5^＋/CK8^＋表型,2例（2.1%）呈现CK5^-/CK8^-表型。这些表型与患者的年龄、肿瘤分级、淋巴结的转移以及临床分期有关;P63在乳腺浸润性导管癌中有8例（8.3%）呈现少量的肿瘤细胞阳性,并且主要表达于低分化的乳腺癌中。结论呈CK5^＋/CK8^＋、CK5^＋/CK8^-或P63^＋表型的乳腺癌恶性程度高、预后差,免疫表型可作为评价预后的生物学指标。     

c-erbB-2基因在乳腺浸润性导管癌及腋窝转移淋巴结中的表达相关性分析

目的:探讨乳腺浸润性导管癌中c-erbB-2的表达及其与腋窝淋巴结等临床病理因素的相关性.方法:采用免疫组织化学方法检测149例乳腺浸润性导管癌患者乳腺原发灶及47例腋淋巴结转移灶中c-erbB-2的表达,结合临床病理因素,分析其相关性.结果:19.46%(29/149)原发灶c-erbB-2高表达,其表达水平与肿瘤大小、腋窝淋巴结转移情况呈正相关,与ER、PR表达呈负相关.47例腋窝淋巴结转移乳腺浸润性导管癌患者中,原发灶c-erbB-2高表达18例(38.30%),腋窝淋巴结转移灶c-erbB-2高表达16例(34.04%),两者差异无统计学意义(P>0.05).5例原发灶c-erbB-2阴性或低表达患者腋窝淋巴结转移呈高表达,7例原发灶c-erbB-2高表达患者淋巴结转移呈阴性或低表达,变化率为25.53%(12/47).结论: c-erbB-2可以作为预测乳腺癌预后的指标,指导术后治疗,但应当考虑c-erbB-2在原发灶和复发转移灶之间的差异,有必要对复发转移灶进行c-erbB-2检测.     

OPN在乳腺癌淋巴结转移中的作用

目的:探讨骨桥蛋白（OPN）在乳腺癌中的表达及其与腋窝淋巴结转移之间的关系。方法:采用免疫组织化学方法检测 66例乳腺癌、28例乳腺良性肿瘤、37例癌旁乳腺组织和29组腋窝转移淋巴结中OPN的表达，分析OPN表达与腋窝淋巴结转移及其他临床病理特征的关系。结果:乳腺癌组织中OPN的表达水平（4.83）明显高于癌旁乳腺组织（1.86）和乳腺良性肿瘤（2.18)（P＜0.01)；乳腺癌淋巴结转移阳性组与阴性组之间、乳腺癌原发病灶与相应的腋窝转移淋巴结之间OPN表达差异有统计学意义（P=0.048,0.03）。乳腺癌c erbB 2阳性表达组OPN表达水平（5.22）高于c erbB 2阴性组（4.00），但差异无统计学意义（P=0.056）。乳腺癌OPN表达与患者年龄、肿瘤大小、转移淋巴结数量、组织学类型、肿瘤分级以及TNM分期无关（P＞0.05），而与淋巴结转移有关（P=0.048）。结论:OPN在乳腺癌组织中高表达，且与乳腺癌腋窝淋巴结转移密切相关。     

乳腺浸润性导管癌RSPO1、β-catenin表达及其特点

探究R-脊椎蛋白1(RSPO1)、β-连环蛋白（β-catenin）与乳腺浸润性导管癌临床病理特征的关系。2017年5月—2020年5月,256例乳腺浸润性导管癌患者,采用免疫组化染色法检测RSPO1、β-catenin在癌组织及癌旁正常组织中表达水平,分析RSPO1、β-catenin表达与乳腺浸润性导管癌患者临床病理特征及预后的关系。结果显示,乳腺浸润性导管癌患者癌组织中RSPO1、β-catenin阳性表达率显著高于癌旁正常组织（P<0.05）;月经状态、年龄、肿瘤直径不同的乳腺浸润性导管癌患者癌组织中RSPO1、β-catenin表达水平差异无统计学意义（P>0.05）;组织学分级、淋巴结转移、TNM分期不同的乳腺浸润性导管癌患者癌组织中RSPO1、β-catenin表达水平差异有统计学意义（P<0.05）;RSPO1、β-catenin阳性表达的乳腺浸润性导管癌患者5年无进展生存率显著低于RSPO1、β-catenin阴性表达的乳腺浸润性导管癌患者（P<0.05）。结果表明,RSPO1、β-catenin在乳腺浸润性导管癌中呈高表达,其表达水平与乳腺浸...     

Syk在不同乳腺病变组织中的表达及临床意义

目的：探讨不同乳腺病变组织中脾酪氨酸激酶（Syk）表达差异,并分析Syk表达与乳腺癌临床及其他病理学指标的关系。方法：用免疫组化法检测20例纤维囊性乳腺病组织、16例乳腺DIN2组织（导管原位癌,中级别）、168例乳腺浸润性导管癌组织及95例癌旁组织中Syk蛋白的表达,并检测乳腺癌组织中ER、PR、p53、HER2/neu表达。结果：纤维囊性乳腺病组织、乳腺DIN2组织、乳腺癌组织及其癌旁组织中Syk阳性表达率分别为90.00%（18/20例）、50.00%（8/16例）、34.52%（58/168例）及78.95%（75/95例）。乳腺癌组织中Syk阳性表达率较纤维囊性乳腺病组织（P〈0.05）及乳腺癌旁组织（P〈0.05）明显降低。乳腺DIN2组织中Syk阳性表达率较纤维囊性乳腺病组织（P〈0.05）及乳腺癌旁组织（P〈0.05）明显降低。Syk表达与肿瘤大小、组织学分级、淋巴结转移、肿瘤分期及ER、PR、p53、HER2/neu表达结果均无相关性。结论：Syk在纤维囊性乳腺病、癌旁组织、癌前期病变和乳腺癌组织中的阳性表达率依次降低。     

120例甲状腺癌诊断和外科治疗

目的：探讨甲状腺癌的诊断及外科治疗方法。方法：行单纯肿物切除32例,行患侧腺叶次全切除19例,患侧腺叶全切除19例,患侧腺叶及峡部切除33例,甲状腺近全切除12例和双侧甲状腺全切除5例,同时行颈部淋巴结清扫术者37例,二次手术40例。结果：无手术死亡,术后声音嘶哑5例,手足麻木3例,饮水呛咳1例,1例2年后出现肝转移。结论：对甲状腺肿物应综合病史、查体、超声检查、CT、ECT、细针穿刺细胞学检查等,对可疑恶性病变者,应行术中冰冻检查。手术方式应根据病变性质、TNM分期及病人情况而采取个体化方案。     

甲状腺手术后低钙血症386例临床分析

目的 探讨甲状腺手术后低钙血症的发生规律和相关因素及治疗方法。方法 对2001年1月至2006年1月收治的2357例行甲状腺手术病人，分析监测术后血清钙的变化。结果 甲状腺手术后出现低钙血症386例．其中单侧腺叶次全切除术13例，均无症状；双侧腺叶全切术14例，一侧腺叶全切除并时侧腺叶次全切除术304例，双侧叶甲状腺次全切除术53例，一侧腺叶全切除并对侧部分切除术2例。专科医师手术出现低钙血症222例（11．8％，222／1886），非专科医师手术出现低钙血症164例（34．8％，164／471）。结论 双侧叶甲状腺全切除、一侧腺叶全切除加对侧腺叶次全切除、双侧叶甲状腺次全切除术，包括再次或二次以上手术，术后易出现低钙血症。甲状腺手术引起低钙血症与医师经验有关。     

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??The value and reasonable choice of total thyroidectomy in the surgical treatment of thyroid cancer TIAN Wen*??YAO Jing. *Department of General Surgery??General Hospital of PLA??Beijing 100853??China
Corresponding author??TIAN Wen??E-mail??tianwen301@sina.com
Abstract Surgery is an important method of thyroid cancer treatment. There are two common surgical methods for thyroid cancer treatment: one is the total resection of cancerous side plus isthmus, the other is the total resection of cancerous side, isthmus, and countralateral resection/total resection, which is known as total thyroidectomy. The tumor type, size, lymph node metastasis, postoperative 131I treatment as well as surgeon’s experience are considered to select specific method reasonable choice. The patients can benefit from total thyroidectomy with a huge mass, multifocal or bilateral foci, the presence of lymph node metastasis, and the lesion can be removed with low recurrences rate. Although, it can not be ignored that its higher incidence of postoperative complication compared with the ipsilateral lobectomy plus isthmus resection. So we should choose carefully the method of thyroidectomy surgery. In addition, total thyroidectomy should be strictly controlled indications and surgical techniques for reducing complications.     

Clinical evaluation of operative procedure for differentiated carcinoma of isthmus of the thyroid

We studied 19 patients who had undergone operation for differentiated carcinoma of isthmus of the thyroid in Shinshu University Hospital from 1967 to 1986. Regarding the operations, total thyroidectomy was performed in 6 cases, subtotal thyroidectomy in 8 cases, lobectomy in one case and isthmectomy in 4 cases. In 12 cases, lymph node dissection was carried out. Among these 12 cases, 6 cases (50%) had evidence of metastasis. Intraglandular metastasis was found in 3 cases. There were no relationship between tumor size and nodal metastasis. From these results, we do not think that total thyroidectomy is indicated in the case of differentiated carcinoma of isthmus of the thyroid. In conclusion, subtotal thyroidectomy with bilateral modified radical neck dissection is sufficient as the operative procedure for differentiated carcinoma of isthmus of the thyroid.     

COMPLETION TOTAL THYROIDECTOMY IN THE MANAGEMENT OF DIFFERENTIATED THYROID CARCINOMA

Background: Completion thyroidectomy is the removal of any thyroid tissue that remains after a less than total thyroidectomy. This procedure has been commonly performed when the final histopathology of the excised ipsilateral thyroid lobe reveals papillary or follicular carcinoma of the thyroid. Complete thyroidectomy carries little morbidity if performed by experienced surgeons using a lateral approach. The purpose of this study is to reinforce the usefulness of a lateral approach. Methods: A retrospective analysis over a 5 year period at the Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) yielded 19 patients who underwent completion thyroidectomy. This group represents 23% of 82 patients who underwent total thyroidectomy for differentiated thyroid cancer (DTC) during that period. The residual thyroid tissue was excised through a lateral approach and could be resected safely, preserving the recurrent laryngeal nerve (RLN) and the parathyroid glands. Results: A lateral approach dissection could be performed with ease in a virgin area. Excision of residual thyroid tissue could be performed safely even in cases with prior partial lobectomy or bilateral subtotal resection. Tumour was found in 52% of the re-operative specimens: in three out of four of those after a previous partial lobectomy, in six out of 12 of those after a total lobectomy, and in one out of three of those after a prior bilateral (although incomplete) thyroid resection. Postoperative complications included transient RLN palsy (n = 2) and transient hypoparathyroidism (n = 4). Conclusions: Completion thyroidectomy using a lateral approach is safe in re-operative thyroid surgery.     

A comparison of total thyroidectomy and lobectomy in the treatment of dominant thyroid nodules

Patients with a clinically concerning dominant thyroid nodule have been managed by lobectomy or total thyroidectomy at our institution. We determined the complications associated with both approaches and the ability of thyroid lobectomy to avoid the need for thyroid hormone replacement therapy. Records of all patients with a dominant thyroid nodule managed with surgery from August 1993 through December 2000 were reviewed for demographics, history of head and neck radiation, indication for surgery, preoperative fine-needle aspirate results, final pathologic evaluation, perioperative complications, determinations of need for subsequent thyroid surgery after lobectomy, and need for thyroid hormone replacement therapy after surgery. Patients with a preoperative diagnosis of malignancy or bilateral or diffuse disease were excluded because these conditions would uniformly be managed by bilateral thyroidectomy. The complications for the lobectomy group (n = 131) compared with the total thyroidectomy group (n = 84) were: recurrent laryngeal nerve paresis (4.6% vs 2.4%), recurrent laryngeal nerve injury (0.8% vs 0), and transient hypoparathyroidism (1.5% vs 9.5%; P = 0.007). No permanent hypoparathyroidism was identified in either group. Postoperative thyroid hormone replacement was required in 64 of 131 lobectomy patients (48.8%). Complications associated with either surgery were low. Total thyroidectomy was not associated with clinically significant additive morbidity. Patients treated by lobectomy should be aware of a nearly 50 per cent chance of requiring thyroid hormone replacement. Total thyroidectomy avoids future thyroid surgery; lobectomy patients remain at risk. When complications can be minimized total thyroidectomy should be considered an option in the management for patients with dominant thyroid nodules that require surgery.     

Thyroid cancer: Some basic considerations

From these data and data from the literature, our recommended treatment for well-differentiated cancer is as follows: For papillary cancer, resection should be adequate to encompass the entire tumor, which in most cases would be complete lobectomy and possibly isthmusectomy. Prophylactic neck dissection is of no value; therapeutic modified neck dissection should be done for stage II disease. Follicular cancer can be treated by lobectomy (for small lesions) or subtotal thyroidectomy. Although total or near-total thyroidectomy may be required in selected patients with large primary cancers or in those with extensive capsular invasion or extrathyroid extension, the number of cases indicating this is small. There were only a few such patients with large primaries requiring total thyroidectomy in this study. Total thyroidectomy is best avoided in most cases, considering the price of hypoparathyroidism and the lack of a significant improvement in survival compared with lesser ablative techniques. Postoperative ablation with iodine-131 did not improve survival in staged patients with papillary cancer (the number of patients with follicular cancer was too small for analysis). Postoperative thyroid suppression by exogenous thyroid hormone postoperatively appeared to improve survival. Although the data were not adequate for evaluation in follicular cancer, there seems to be no reason not to use this postoperatively in high risk patients with either papillary or follicular cancer.     

Minimal thyroid carcinoma: A report of nine cases discovered by cervical lymph node metastases

From 1962 to 1983, nine patients with minimal carcinoma of the thyroid were referred to Aichi Cancer Center Hospital and to Aichi Medical University Hospital for evaluation of enlarged lymph nodes in the neck. The radiographic study and scintigraphy of the thyroid were useful in detection of small thyroid lesions. In two cases, a lymph node biopsy was required for confirmation of the diagnosis. The thyroid lesions were histologically papillary carcinoma, in all the cases. A modified neck dissection with total thyroidectomy was carried out in five patients and modified neck dissection with thyroid lobectomy was done in four cases. Nine patients were followed for 6 months to 20 years and all the patients except one are alive.     

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??Treatment of thyroid microcarcinoma DAI Wen-jie, ZHU Hua-qiang, JIANG Hong-chi. Department of General Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
Corresponding author: DAI Wen-jie,, E-mail: wenjdai@yahoo.com.cn
Abstract Objective To study on the treatment of thyroid microcarcinoma. Methods Retrospective study was performed on the treatment of 141 cases of thyroid microcarcinoma admitted between January 2002 and January 2007 at the First Affiliated Hospital of Harbin Medical University. Different extent of thyroidectomy and lymphadenectomy were performed on different patients according to their diagnostic procedures. Therapeutic effect of different treatments and the factors associated with the presence of lymph node metastases were analyzed. Results One hundred and seventeen cases were diagnosed preoperatively or intraoperatively, and were treated with ipsilateral total lobectomy +isthmusectomy + contralateral subtotal lobectomy, or bilateral total / near-total / subtotal thyroidectomy. Four of them recurred (3.4%). Twenty-one cases were diagnosed as benign thyroid diseases preoperatively and intraoperatively, but incidentally detected as malignancy after the operation. They were firstly treated with ipsilateral subtotal lobectomy. Reoperation was not performed because all of them were single focal without capsular or vascular effraction. None of them recurred. Lymphadenectomy was performed in 27 cases with lymphadenectasis, and 3 of them recurred (11.1% ). Lymphadenectomy was not performed in another 114 cases without lymphadenectasis, and only 2 of them recurred (1.8%). Conclusion The surgical treatment of thyroid microcarcinoma should be individualized based on the patient and tumour. Lymph node metastases are common in thyroid microcarcinoma patients. The factors correlated with the presence of lymph node metastases were multifocal, capsular effraction, and tumor size (≥5mm). Lymphadenectomy is necessary for patients with lymphadenectasis, but is unnecessary for patients without lymphadenectasis.     

Total or near total thyroidectomy versus limited resection for radiation-associated thyroid nodules: a twelve-year follow-up of patients in a thyroid screening program

Controversy continues regarding the extent of thyroidectomy appropriate for patients with radiation-associated thyroid nodules. The incidence of cancer in this group of patients is more than 50% when near total or total thyroidectomy is done and all thyroid tissue is serially sectioned and examined. Tumor multicentricity is common. Is total or near total thyroidectomy warranted in all of these patients? A prospective study and follow-up program of 2118 patients with prior low-dose head and neck irradiation who entered into a thyroid screening program allowed us to examine how the extent of thyroidectomy influenced the clinical course of these patients. Near total or total thyroidectomy was performed in 59 patients (36 had cancer), and limited thyroid resection, that is, lobectomy or less, was done in 78 patients (four of whom had cancer). During follow-up, only three patients have developed recurrent cancer; two had near total thyroidectomy and one had total thyroidectomy at first operation. Two patients with limited thyroid resection have had reoperation for new thyroid nodules, both of whom had benign nodules. We conclude that although limited thyroid resection may leave occult malignancies in unresected thyroid tissue, there is no significant difference in outcome between patients with limited resection and those with near total or total thyroidectomy after a 12-year follow-up of the program. Significant differences in cancer recurrence rats may occur with longer follow-up.