Background:Information regarding DICER1-related thyroid tumors in children has accumulated; however, the clinical, molecular and radiological characteristics of thyroid nodules with DICER1 mutations in adults are largely unknown, especially those with somatic mutations. Objective:In this study, we sought to find clinical, molecular and radiological characteristics of thyroid diseases with somatic mutations in the DICER1 gene in adults. Patients:Patients (n = 21) aged ≥18 years with somatic DICER1-related thyroid tumors were enrolled. Design:From 1,289 patients who underwent genotyping for PTC-associated variants, 21 patients with 23 DICER1-related thyroid tumors and confirmed somatic DICER1 variants were selected and analyzed for clinical, molecular and radiographic features. Results:Somatic DICER1 variants were found in 21 of 1,289 (1.63%) patients with thyroid nodules in this study. All patients were female predominant. Eleven (11/23) were classified as benign and eight (8/23) were malignant, one was a follicular tumor of uncertain malignant potential (FT-UMP) with suspicious capsular invasion and three were under follow-up, in 23 DICER1-related nodules. Eleven nodules (11/23) had other pathogenic gene mutations (RAS and BRAF), and biallelic DICER1 mutations had a high prevalence, about 34.8% (8/23). Ten nodules (10/20) were combined with other tumors with non-DICER1 mutations. No patients had any local invasion or distant metastasis during follow-up. All DICER1-related nodules lacked unique sonographic features, but had the typical appearance of benign or malignant nodules on ultrasound (US). Conclusion:Somatic DICER1-mutated thyroid nodules in adults usually represent a distinct class of low-risk neoplasms, although they may be accompanied by variants in other thyroid cancer-related genes.

The impact of parathyroid gland autotransplantation on permanent hypoparathyroidism remains incompletely understood. This study aimed to ascertain how selective autotransplantation of parathyroid glands affects the occurrence of permanent hypoparathyroidism after total thyroidectomy with central neck dissection (CND). A retrospective cohort study encompassed consecutive patients with papillary thyroid carcinoma who underwent primary total thyroidectomy plus CND from January 2008 to December 2010 and January 2012 to December 2019. Patients were categorized into two groups (0 and ≥1 parathyroid glands autotransplanted, respectively). The autotransplantation group comprised 501 patients, while the non-autotransplantation group comprised 652 patients. The autotransplantation group showed significantly lower permanent hypoparathyroidism than the non-autotransplantation group [1.2% (6 of 501) vs. 4.4% (29 of 652), P = 0.001]. Out of the total 1,153 patients, 652 (56.5%) had no autotransplanted glands, and 358 (31.0%), 136 (11.8%), and 7 (0.6%) had 1, 2, and 3 glands autotransplanted, respectively. As the number of autotransplanted glands increased (from 0 to 3), the prevalence of permanent hypoparathyroidism was 4.4% (29 of 652), 1.4% (5 of 358), 0.7% (1 of 136), and 0.0% (0 of 7), respectively (P = 0.016). Multivariate logistic analysis revealed that parathyroid autotransplantation independently prevented postoperative permanent hypoparathyroidism. Selective parathyroid autotransplantation is associated with a lower risk of permanent postoperative hypoparathyroidism. Autotransplantation is recommended for parathyroid glands that are devascularized or challenging to preserve in their original location.

Small gastric subepithelial tumors (SETs) in the stomach can be managed through surveillance or resection. However, it is still controversial how often the lesion would progress if left untreated. This study aimed to evaluate the progression rate of small SETs and identify risk factors influencing tumor growth. PubMed, Cochrane Library, Web of Science, and Scopus were searched for relevant studies until March 2023. Patient information, endoscopic features of SETs, and surveillance information were extracted from each included study. A random-effects model was applied along with subgroup and sensitivity analyses. Based on 14 studies with 5405 SETs smaller than 3.5 cm, the annual incidence of size increase was 4.0 (95

The main purpose of the reported endoscopic thyroidectomy with the several incisions on the chest wall or other approaches was to meet the cosmetic demands of patients, but they had inherent technical disadvantages. To solve these problems, we developed a single-incision gasless trans-subclavian approach endoscopic thyroidectomy and evaluated its feasibility. We reviewed clinical data from 243 consecutive patients who underwent gasless trans-subclavian approach endoscopic thyroidectomy with a single incision at our centre from January 2021 to March 2022. Patients’ basic information, the extent of surgery, the duration of surgery, the number of lymph node dissection, postoperative hospital stay, complications, and follow-up outcomes were collected and analysed. No cases converted to open surgery. The mean time for lobectomy + central neck dissection was 84.9 ± 29.9 min and 95.0 ± 24.3 min for lobectomy. The mean number of lymph node dissection in the central compartment was 5.6 ± 3.9, with a mean number of metastatic lymph nodes of 0.8 ± 1.6. Temporary recurrent laryngeal nerve (RLN) injury occurred in eigth patients, and minor lymphatic fistula occurred in one patient. During at least 6 months of follow-up, one patient was found to have a recurrence of lateral neck lymph nodes by ultrasound 6 months after surgery. The single-incision gasless trans-subclavian approach endoscopic thyroidectomy is a feasible and truly minimally invasive procedure for selected patients, providing a scarless cervical appearance. Given the simplicity and ease of learning, this surgical technique is well-suited for widespread clinical application.

Background & aims There is limited clinical data regarding the additional yields of random biopsies during colorectal cancer surveillance in patients with inflammatory bowel disease. To assess the additional yield of RB, a systematic review and meta-analysis was conducted. Methods PubMed, Embase, Web of Science, and the Cochrane Library were searched for studies investigating the preferred colonoscopy surveillance approach for IBD patients. The additional yield, detection rate, procedure time, and withdrawal time were pooled. Results Thirty-seven studies (48 arms) were included in the meta-analysis with 9051 patients. The additional yields of RB were 10.34% in per-patient analysis, and 16.20% in per-lesion analysis. The detection rate were 1.31% and 2.82% in per-patient and per-lesion analysis, respectively. Subgroup analysis showed a decline in additional yields from 14.43% to 0.42% in the per-patient analysis and from 19.20% to 5.32% in the per-lesion analysis for studies initiated before and after 2011. In per-patient analysis, the additional yields were 4.83%, 10.29%, and 56.05% for PSC proportions of 0-10%, 10-30%, and 100%, respectively. The corresponding detection rates were 0.56%, 1.40%, and 19.45%. In the per-lesion analysis, additional yields were 11.23%, 21.06%, and 45.22% for PSC proportions of 0-10%, 10-30%, and 100%, respectively. The corresponding detection rates were 2.09%, 3.58%, and 16.24%. Conclusions The additional yields of RB were 10.34% and 16.20% for per-patient and per-lesion analyses, respectively. Considering the decreased additional yields in studies initiated after 2011, and the influence of PSC, endoscopy centers lacking full HD equipment should consider incorporating RB in the standard colonoscopy surveillance for IBD patients, especially in those with PSC.

BACKGROUND AND AIMS:Hemostatic powder (HP) is a novel hemostasis modality for nonvariceal GI bleeding. This meta-analysis was performed to evaluate the efficacy of HP monotherapy versus conventional endoscopic treatment (CET) for nonvariceal GI bleeding. METHODS:PubMed, EMBASE, and Cochrane Library databases were systematically searched from inception to October 16, 2023. The primary outcomes were the initial hemostatic rate and the 30-day recurrent bleeding rate. After the meta-analysis, a trial sequential analysis (TSA) was also conducted to decrease the risk of random errors and validate the result. RESULTS:The meta-analysis included 8 studies, incorporating 653 patients in total. Given significant heterogeneity, all analyses were segregated into malignancy-related and nonmalignancy-related GI bleeding lesions. For the former, HP monotherapy significantly improved the initial hemostasis rate and 30-day recurrent bleeding rate compared with CET (relative risk [RR], 1.50; 95% confidence interval [CI], 1.28-1.75; P < .001; RR, .32; 95% CI, .12-.86; P = .02, respectively), and TSA supported the results. For nonmalignancy-related GI bleeding, HP monotherapy and CET have similar initial hemostasis and 30-day recurrent bleeding rates (RR, 1.08; 95% CI, .98-1.19; P = .11; RR, 1.15; 95% CI, .46-2.90; P = .76, respectively), but the TSA failed to confirm the results. CONCLUSIONS:HP monotherapy surpassed CET in terms of the initial hemostasis rate and 30-day recurrent bleeding rate for patients with malignancy-related GI bleeding. However, their relative efficacy for nonmalignancy-related GI bleeding remains unresolved.

Objectives Based on different physicochemical properties, common submucosal injection solutions could be classified into three categories: normal saline solution (NS), hypertonic solution (HS), and viscous solution (VS). We compared the efficacy and safety of various categories of solutions in this network meta‐analysis of randomized controlled trials (RCTs) to identify the optimal submucosal injection fluid. Methods PubMed, Embase, Web of Science, and the Cochrane Library were searched for RCTs that compared the efficacy and safety of NS, HS, and VS during endoscopic resection for gastrointestinal (GI) mucosal lesions. Pairwise and network analyses were conducted to determine the ranking of different fluids. Results Thirteen RCTs were included in the final analysis with 1637 patients (1639 lesions). HS outperformed NS in rates of en bloc (pooled relative risk [RR] 1.50; 95% confidence interval [CI] 1.10–1.90), overall bleeding (pooled odds ratio [OR] 0.33; 95% CI 0.10–0.88; lesions >10 mm OR 4.65 × 10 −2 ; 95% CI 1.10 × 10 −3 –0.46), and intraoperative bleeding (lesions >10 mm OR 7.10 × 10 −6 ; 95% CI 4.30 × 10 −18 –0.26). HS showed the highest probability of ranking first in each outcome except for the volume of injection. Although VS was superior to NS in rates of en bloc, overall, and intraoperative bleeding in the lesions >10 mm subgroup, and required less fluid in pooled analysis, it ranked last in cost of submucosal injection solution. Conclusions Both HS and VS were superior to NS in comparisons of efficacy and safety. Considering the better performance and potentially low cost, HS might be an optimal choice during gastrointestinal endoscopic resection, especially for colorectal endoscopic mucosal resection.

INTRODUCTION:The dysregulation of the c-Jun NH2-terminal kinase (JNK) pathway has been increasingly reported in human malignancies. Aberrant expression of the JNK pathway has also been implicated in the progression of Esophageal Squamous Cell Carcinoma (ESCC). However, the specific role and regulatory mechanisms of JNK2 in ESCC have not been extensively investigated.METHODS:In this study, we examined JNK2 expression in patient samples and performed experiments involving the knockdown and inhibition of the JNK2 in ESCC cell lines.RESULTS:Higher JNK2 expression was observed in tumor tissues compared to adjacent tissues. JNK2 overexpression was associated with advanced disease stages and poor prognosis. Furthermore, knockdown or inhibition of JNK2 in ESCC cell lines resulted in a decrease in cell proliferation and migration.CONCLUSION:Additionally, a significant decrease in the expression of β-catenin and vimentin, along with an increase in the expression of Axin2, was observed upon downregulation of JNK2. Our study provides insight into the role of JNK2 in ESCC and its potential regulatory mechanism, offering a potential therapeutic strategy for ESCC patients with aberrant JNK2 expression.

Objective:To study the practical efficacy of the clinical decision support system for diagnosis and treatment of thyroid cancer (CDSS-TC) in assisting doctors to complete several diagnosis and treatment tasks, and to make a preliminary evaluation of its clinical practicability according to the test results.Methods:From Jan. 2022 to Mar. 2022, 90 patients with thyroid cancer who were admitted to the Head and Neck Surgery Department of Shaw Hospital affiliated to Zhejiang University were prospectively analyzed, and the average time spent in reading the pre-operative B-ultrasound report, as well as the individual fitness of the dose adjustment of eugenol in 70 patients with thyroid cancer after surgery. A retrospective analysis was made of the compliance of the basis of the "recommended scheme" and the deviation of the basis of the doctor’s "final scheme" for the preoperative surgery of 120 patients with thyroid cancer who were treated for the first time in the head and neck surgery of Shaw Hospital affiliated to Zhejiang University from Mar. 2021 to May. 2021. All cases were treated by pure artificial (group A) and CDSS-TC assisted (group B) , and the differences in organization were compared.Results:The average time for disposal of a single B-ultrasound report in Group B was much shorter than that in Group A ( P=5.600E-04) ; The number of patients with excellent grade and the total number of patients with excellent grade and qualified grade recommended by the doctor in group B were significantly higher than those in group A ( P=7.819E-20 and P=1.335E-18) ; The conformity rate of the basis of CDSS-TC "Recommended Scheme" ≥ 98%; The deviation rate of the basis for "final protocol" of doctors in group B was lower than that in group A ( P=0.059 for total resection or not, P=0.075 for lateral neck dissection or not) . Conclusions:CDSS-TC can accurately extract the disease-related source information in all the original examination/laboratory reports, and provide accurate decision-making suggestions through efficient correlation analysis. In view of the accurate and objective conclusions of its analysis, it can provide high-quality and all-link decision support for doctors’ clinical diagnosis and treatment, and is an ideal information work platform.

Objective:To explore the threshold and efficacy of thyroglobulin assessment in the needle washout after fine needle aspiration (FNA-Tg) in the preoperative diagnosis of cervical lymph metastasis of thyroid papillary carcinoma (PTC).Methods:A retrospective analysis was performed on the FNA-Tg results of a total of 541 lymph nodes in 410 patients who underwent thyroid node surgery at the Department of Head Neck Surgery, Sir Run Run Shaw Hospital of Zhejiang University College of Medicine from July 2016 to January 2018. Taking the postoperative lymph node pathological results as the "gold standard", the ROC curve was plotted to obtain the optimal diagnostic threshold of FNA-Tg for cervical lymph node metastasis and evaluate its diagnostic efficacy. According to the level of serum thyroglobulin (sTg), the lymph nodes were divided into either a low sTg group (sTg ≤10 ng/ml) or a high sTg group (sTg >10 ng/ml), the ROC curve was plotted to analyze the diagnostic threshold of FNA-Tg in the two groups. The diagnostic threshold and efficacy of FNA-Tg/sTg ratio and FNA-Tg-sTg difference were then analyzed.Results:The ROC curve of FNA-Tg for diagnosis of lymph node metastasis was plotted, and the optimal diagnostic threshold of FNA-Tg was determined to be 0.835 ng/ml. Using this threshold as the cut-off point, the sensitivity and specificity were 88.5% and 97.5%, respectively, and the area under the ROC curve (AUC) was 0.944 (95%CI: 0.914~0.974). The level of FNA-Tg was correlated with the level of sTg (r=0.350, P＜0.001). Then, the lymph nodes were divided into either a low sTg group (n = 296) or a high sTg group (n = 245) according to the level of sTg, and the optimal diagnostic threshold for the two groups was determined to be 0.825 ng/ml (AUC = 0.909, 95%CI: 0.838~0.981) and 0.875 ng/ml (AUC = 0.951, 95%CI: 0.918~0.984), respectively. The optimal diagnostic cut-off of FNA-Tg/sTg ratio was determined to be 0.145; using this cut-off, the AUC of FNA-Tg/sTg ratio was 0.922 (95%CI: 0.889~0.955), and the sensitivity, specificity, positive predictive value, and negative predictive value were 82.7%, 95.5%, 85.3%, and 94.3%, respectively. The optimal diagnostic cut-off of FNA-Tg-sTg difference was determined to be >0; using this cut-off, the AUC of FNA-Tg-sTg difference was 0.841 (95%CI: 0.802~0.879), and the sensitivity, specificity, positive predictive value, and negative predictive value were 74.8%, 93.3%, 79.4%, and 91.5%, respectively.Conclusion:FNA-Tg can be used for the preoperative diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma. When 0.835 ng/ml is used as the cut-off value of FNA-Tg, the diagnostic performance is better. To avoid the possible impact of sTg level, FNA-Tg/sTg ratio and FNA-Tg-sTg difference could be used in combination.

The pink-color sign (PCS) has been widely used for diagnosing esophageal squamous cell carcinoma (ESCC) during Lugol’s iodine chromoendoscopy. However, the identification of the PCS only relies on the subjective assessments made by the endoscopist, which could lead to bias and disagreement. Previous research has indicated that the V′ variable can, as an objective index, define the PCS in the LU′V′ color space. We aimed to validate the diagnostic performance of the PCS defined by the V′ variable alone and attempt to improve the diagnostic performance by combining the V′ and U′ variables. We re-examined 231 subjects with Lugol’s unstained lesions (LULs) from a previously reported prospective trial. The diagnostic performance of the method using V′ variable alone (V′ alone method), the combination method using V′ and U′ variables (V′ + U′ method), and the endoscopists were calculated and compared. A total of 236 LULs were included, among which 46 were histologically confirmed to be cancerous lesions. The sensitivity, specificity, and accuracy of the V′ alone method were 73.91

Endoscopic resection (ER) is widely applied to treat early colorectal cancer (CRC). Predicting the invasion depth of early CRC is critical in determining treatment strategies. The use of computer-aided diagnosis (CAD) algorithms could theoretically make accurate and objective predictions regarding the suitability of lesions for ER indication based on invasion depth. This study aimed to assess diagnostic test accuracy of CAD algorithms in predicting the invasion depth of early CRC and to compare the performance between the CAD algorithms and endoscopists. Multiple databases were searched until June 30, 2022 for studies that evaluated the diagnostic performance of CAD algorithms for invasion depth of CRC. Meta-analysis of diagnostic test accuracy using a bivariate mixed-effects model was performed. Ten studies consisting of 13 arms (13,918 images from 1472 lesions) were included. Due to significant heterogeneity, studies were stratified into Japan/Korea-based or China-based studies. For the former, the area under the curve (AUC), sensitivity, and specificity of the CAD algorithms were 0.89 (95

Lugol's iodine chromoendoscopy is the method commonly used to detect and diagnose esophageal squamous cell carcinoma [1] [2]. The conventional method of spraying iodine requires iodine solution diluted from the stock solution, a spraying catheter, and cooperation between the endoscopist and the assistant. Here, we report a novel syringe method for iodine spraying without the above requirements.

Objectives Nonvariceal gastrointestinal bleeding (NVGIB) is a common medical condition with significant mortality and morbidity. Several types of hemostatic modalities are currently available in clinical setting. This systematic review and network meta‐analysis aimed to assess the efficacy of these modalities in treating NVGIB. Methods PubMed, EMBASE, and the Cochrane Library databases were searched for studies that compared the efficacy of different hemostatic techniques (over‐the‐scope clip [OTSC], hemostatic powder [HP] and conventional endoscopic treatment [CET]) for NVGIB published up to June 2022. The 30‐day rebleeding rate was regarded as the primary outcome. We performed pairwise and network meta‐analyses for all treatments. The heterogeneity and transitivity were evaluated. Results Twenty‐two studies were included. Regarding the 30‐day rebleeding rate, OTSC and HP plus CET showed superior efficacy in treating NVGIB compared with CET (OTSC vs CET: relative risk [RR] 0.42, 95% confidence interval [CI] 0.28–0.60; HP plus CET vs CET: RR 0.40, 95% CI 0.17–0.87), while OTSC and HP plus CET had comparable efficacy (RR 0.95, 95% CI 0.38–2.31). HP plus CET ranked the highest in the network ranking estimate. The sensitivity analysis showed that it was not robust that OTSC was superior to CET regarding the short‐term rebleeding rate and the initial hemostasis rate. While all‐cause mortality, bleeding‐related mortality and necessity of surgical or angiographic salvage therapy showed no statistically significant difference. Conclusion OTSC and HP plus CET significantly reduced 30‐day rebleeding rate compared to CET and had comparable efficacy in the treatment of NVGIB.

Nonvariceal gastrointestinal bleeding (NVGIB) is a common medical condition with significant mortality and morbidity. Several types of hemostatic modalities are currently available in clinical setting. This systematic review and network meta-analysis aimed to assess the efficacy of these modalities in treating NVGIB. PubMed, EMBASE, and the Cochrane Library databases were searched for studies that compared the efficacy of different hemostatic techniques (over-the-scope clip [OTSC], hemostatic powder [HP] and conventional endoscopic treatment [CET]) for NVGIB published up to June 2022. The 30-day rebleeding rate was regarded as the primary outcome. We performed pairwise and network meta-analyses for all treatments. The heterogeneity and transitivity were evaluated. Twenty-two studies were included. Regarding the 30-day rebleeding rate, OTSC and HP plus CET showed superior efficacy in treating NVGIB compared with CET (OTSC vs CET: relative risk [RR] 0.42, 95% confidence interval [CI] 0.28–0.60; HP plus CET vs CET: RR 0.40, 95% CI 0.17–0.87), while OTSC and HP plus CET had comparable efficacy (RR 0.95, 95% CI 0.38–2.31). HP plus CET ranked the highest in the network ranking estimate. The sensitivity analysis showed that it was not robust that OTSC was superior to CET regarding the short-term rebleeding rate and the initial hemostasis rate. While all-cause mortality, bleeding-related mortality and necessity of surgical or angiographic salvage therapy showed no statistically significant difference. OTSC and HP plus CET significantly reduced 30-day rebleeding rate compared to CET and had comparable efficacy in the treatment of NVGIB.

Background:The development of transoral endoscopic vestibular approach thyroidectomy (TOETVA) has been limited by inherent defects, such as mental nerve injury and carbon dioxide (CO2)-related complications. Herein, we proposed a new technique without CO2 called gasless submental-transoral combined approach endoscopic thyroidectomy (STET) to solve the problems in TOETVA.Methods:We reviewed 75 patients who successfully underwent gasless STET using novel instruments at our institution from November 2020 to November 2021. A main incision of approximately 2 cm was made in the natural submental crease line and then combined with two vestibule incisions to complete the procedure. Demographic data, surgical technique and perioperative outcomes were retrospectively recorded.Results:Thirteen male and sixty-two female patients with a mean age of 34.0 ± 8.1 years were enrolled in this study. Sixty-eight patients had papillary thyroid carcinomas and seven had benign nodules. We successfully performed all gasless STET without conversion to open surgery. The average postoperative hospital stay was 4.2 ± 1.8 days. One transient recurrent laryngeal nerve injury and two transient hypoparathyroidisms were observed. Three patients complained of slight lower lip numbness on the first postoperative day. One case of lymphatic fistula, subcutaneous effusion, and incision swelling occurred each, all of which were conservatively cured. One patient developed a recurrence six months after surgery.Conclusions:Gasless STET using our own designed suspension system is technically safe and feasible with reasonable operative and oncologic results.

Background The BRAF V600E mutation is the most common genetic variant in papillary thyroid cancer (PTC), but the relationship between the BRAF V600E mutation in PTC and cervical lymph node metastasis (LNM) remains controversial. Objective To estimate risk factors for neck nodal metastasis in PTC with BRAF V600E mutation. Patients A total of 292 patients diagnosed with BRAF V600E mutation related PTC were admitted. Design In this retrospective study, data from 292 patients, including clinical, molecular, and ultrasonic characteristics, were analyzed. Univariate and multivariate logistic regression analyses were applied to identify risk factors for LNM in PTC with the BRAF V600E mutation. Results In the univariate analysis of all PTC patients with the BRAF V600E mutation, the LNM was found to be significantly associated with age (P = 0.010), size (P = 0.000), bilaterality (P = 0.000), multifocality (P = 0.002), LNM in ultrasound (US) (P = 0.000), and capsular invasion (P = 0.010). In ultrasonic image characteristics, margin (P = 0.036), shape (P = 0.046), and microcalcification (P = 0.002) were significantly associated with LNM. In multivariate analysis, LNM in PTCs with BRAF V600E mutation was significantly associated with age ≤ 45 years (OR = 1.869, P = 0.020, 95% CI = 1.106 - 3.158), size ≥ 1cm (OR = 3.131, P = 0.001, 95% CI = 1.578 - 6.212), LNM in US (OR = 6.962, P = 0.000, 95% CI = 2.924 - 16.572), bilaterality (OR = 1.626, P = 0.007, 95% CI = 1.142 - 2.314), ill-defined margins in US (OR = 1.980, P = 0.033, 95% CI = 1.057 - 3.709), and microcalcification in US (OR = 2.786, P = 0.002, 95% CI = 1.464 - 5.303). Conclusion This study revealed that several significant risk factors for LNM in PTCs with the BRAF V600E mutation included: age ≤ 45 years, size ≥ 1cm, LNM in US, bilaterality, ill-defined margins in US, and microcalcification in US.

目的 探讨改良无充气经锁骨下入路腔镜甲状腺手术治疗甲状腺乳头状癌的可行性和安全性.方法 回顾性分析2021年1～7月在浙江大学医学院附属邵逸夫医院头颈外科接受改良无充气经锁骨下入路腔镜甲状腺手术的70例甲状腺乳头状癌病人的临床资料.记录手术时间、中央区完全显露率、住院时间、清扫淋巴结数目及术后并发症.采用门诊随访方式,随访截止时间为2022年1月.结果 所有病例均顺利在腔镜下完成手术,无中转开放手术.甲状腺乳头状癌最大直径为6(2～30)mm,中央区淋巴结获取数目为4(0～19)枚.中央区完全显露率为92.8％(65/70).手术时间为95(65～145)min,术后住院时间为4(2～5)d.暂时性喉返神经损伤1例,皮下积液1例,局部红肿2例,均经保守治疗痊愈.无术后出血发生.随访过程中无肿瘤残留或复发.结论 改良无充气经锁骨下入路腔镜甲状腺手术治疗甲状腺乳头状癌安全可行,中央区淋巴结清扫彻底,切口隐蔽性好,有临床运用价值.

Objective: To investigate the sonographic features of primary thyroid lymphoma (PTL) and to evaluate the clinical significance of ultrasound-guided core needle biopsy (US-CNB) in PTL. Methods: A total of 24 patients with suspected PTL in Sir Run Run Shaw Hospital from January 2013 to June 2018 were analyzed retrospectively. All cases were confirmed by pathology, of them 23 patients received US-CNB and 1 patient chose operation without US-CNB, including 5 males and 19 females, aged from 39 to 75 years old. The effectiveness and safety of 23 patients with US-CNB were evaluated, and the sonographic features of 20 patients with PTL diagnosed by pathology were analyzed. Descriptive statistical methods were used in the study. Results: In the 23 patients with suspected PTL underwent US-CNB, 18 patients were diagnosed as PTL, 4 patients were respectively diagnosed as subacute thyroiditis, anaplastic carcinoma, Hashimoto's thyroiditis, and fibro thyroiditis, and the another patient was hard to diagnose by US-CNB and then was diagnosed as PTL by surgical biopsy. The success rate of US-CNB for diagnosis of PTL was 18/19, and no severe complications occurred in the patients with US-CNB. The other case was diagnosed as PTL by surgical biopsy without US-CNB. Sonographic features of 20 cases with PTL (18 cases diagnosed by US-CNB and 2 cases by surgery or surgery biopsy) were as follows: (1) Most nodules had irregular shapes and unsmooth margins; (2) Hypoechoic or markedly hypoechoic nodules with honeycombed or cord structures were observed in most cases; (3) Calcification was rare; (4) Multiple lesions were common; (5) Abundant intralesional vascularization was commonly observed; (6) Most cases had intensification of posterior acoustic enhancement; (7) Thyroid gland enlargement or with irregular shape; and (8) PTL often accompanied with lymph nodes enlargement in lateral neck or central region. Conclusion: PTL has certain sonographic features, with assistance of US-CNB, more accurate diagnosis of PTL can be obtained.

Objective:To explore superior mediastinal lymph node zoning of thyroid cancer for accurate anatomical definition as a reference for surgical access. Methods:A method for zoning superior mediastinal lymph nodes for thyroid cancer was proposed. From Sep 2018 to Nov 2019, 36 cases of thyroid cancer with superior mediastinal lymph nodes metastases were reviewed. The diagnosis, surgical approaches, pathology, characteristics of lymph node metastasis, complications and follow-up results were analyzed.Results:The superior mediastinal lymph nodes were grouped into 10 areas: 1, 2Ra, 2Rb, 2La, 2Lb, 3A, 3P, 4R, 4La and 4Lb. According to the location of the superior mediastinum metastatic lymph nodes, direct vision approach through the neck incision, laparoscope-assisted approach, thracoscepy, laparoscope-assisted combined with thrascopy approach or conventional median sternotomy was performed for regional lymph node dissection. The average follow-up time was (10±4) months. No residual or recurrence of tumor in superior mediastinal area was found.Conclusions:The zoning of the superior mediastinal lymph nodes in thyroid cancer can be used as a guide for surgical approach to lymph node dissection .