Qiang Shen

Risk Factors for Neck Nodal Metastasis in Papillary Thyroid Microcarcinoma: A Study of 1066 Patients

CONTEXT The surgical management of papillary thyroid microcarcinoma (PTMC), especially regarding the necessity of central lymph node dissection, remains controversial. OBJECTIVE The objective of the study was to describe the clinicopathological features of PTMC and to identify the risk factors for central lymph node metastasis (CLNM) that can guide surgical strategies for patients with PTMC. DESIGN In this retrospective cross-sectional study, risk factors and outcome variables were assessed at the time of surgery for the primary tumor. SETTING The study was conducted at a university-based tertiary care cancer hospital. PATIENTS Data from the medical records of 1066 consecutive patients diagnosed with PTMC over a 5-yr period were analyzed. RESULTS Our multivariate logistic regression analysis found male gender, younger age (≤45 yr of age), multifocal lesions, extrathyroidal extension, and larger size of the primary tumor (>6 mm) to be associated with CLNM; multifocal lesions were associated with the highest risk (odds ratio 4.476, 95% confidence interval 2.975-6.735). Extrathyroidal extension, multifocal lesions, and CLNM were associated with lateral neck lymph node metastasis (LLNM). In patients with a solitary primary tumor, tumor location in the upper third of the thyroid lobe was associated with a lower risk of CLNM and a higher risk of LLNM. CONCLUSIONS Prophylactic central lymph node dissection need be considered in PTMC patients presenting with risk factors. In PTMC patients with a solitary primary tumor, tumor location can assist in the evaluation of LLNM. We recommend multicenter research and long-term follow-up to better understand the risk factors and surgical management of PTMC.

Clinicopathologic study of 1176 salivary gland tumors in a Chinese population: experience of one cancer center 1997-2007.

Abstract Conclusion: Chinese patients have a higher rate of lymphoepithelial carcinoma (LEC) and salivary duct carcinoma (SDC). Comprehensive use of diagnostic modalities, neck dissection, and postoperative radiation will improve the treatment results for salivary gland tumors (SGTs). Objectives: To study the clinicopathological characteristics of SGTs in a Chinese population. Methods: The records of SGT patients operated in a tertiary cancer hospital of China were retrieved. Results: From December 1997 to December 2007, 289 malignant and 887 benign SGTs were operated at Cancer Hospital, Shanghai, China. Pleomorphic adenoma and Warthins tumor were the most common types of SGT. Mucoepidermoid carcinoma (24.6% of malignant cases) and adenoid cystic carcinoma (18.0%) were the most frequent malignant cases, followed by acinic cell carcinoma (12.1%), LEC (9.7%), and SDC (9.3%). The sensitivity and specificity of ultrasound scan, fine needle aspiration biopsy, and frozen section were 58.3 and 88.6%, 87.2 and 96.7%, 86.9 and 99.6%, respectively. Neck dissections and postoperative radiation were carried out for 48.6 and 48.0% of carcinomas, respectively. The percentage of tumors by pathologic TNM stage were 23.7% for stage I, 32.9% for stage II, 17.3% for stage III, and 26.1% for stage IV. The 5-year overall survival rate was 88.0%.

Preoperative CT diagnosis of right nonrecurrent inferior laryngeal nerve

The nonrecurrent inferior laryngeal nerve is an anomaly associated with the absence of the brachiocephalic artery (BCA) and the presence of arteria lusoria.

New clinical features of thyroid cancer in eastern China

OBJECTIVE Analyze recent clinical features of thyroid cancer in eastern China. METHODS Investigation and comparison of clinical data of thyroid cancer patients from 1996 to 2006 from the Department of Head and Neck Surgery in the Cancer Hospital of Fudan University, Shanghai, China. RESULTS The number of patients with thyroid cancer rose from 148 in the year 1996 to 572 in the year 2006, a 3.9-fold increase. Routine ultrasound survey during physical examination revealed four cases (2.7%) in 1996 and 285 cases (49.8%) in 2006. The sensitivity of the ultrasound survey in thyroid cancer diagnosis was 86.66% in 1996 and 88.20% in 2006 (P>0.05). Papillary carcinoma was most prevalent (87.8% in 1996 and 92.8% in 2006). An increasing proportion of small tumors was found. The incidence of microcarcinoma was 35.7% in 2006 in contrast with 20.3% in 1996 (P<0.01). Moreover, tumors with diameter from 1 to 2 cm were found in 38.5% patients in 2006 as opposed to 27.0% in 1996 (P<0.01). Extrathyroid extension was reported in 46 (31.1%) patients in 1996, but only in 39 (6.8%) in 2006 (P<0.01). Central cervical lymph node metastases were found in 98 (66.2%) patients in 1996, contrasting with 301 (52.6%) in 2006 (P<0.05). Thirty-seven (25.0%) patients had lateral cervical lymph node metastasis in 1996 compared with 117 (20.5%) in 2006 (P>0.05). Last, the proportion of stage I cancers in 2006 was higher than that in 1996. CONCLUSION With the increasing incidence of thyroid cancer, cancer was discovered at an earlier stage. This is due to new clinical features of thyroid cancer, such as the decrease in tumor diameter, the lower rate of extrathyroid extension and of cervical lymph node metastasis. Routine ultrasound survey during physical examination has become the most common way to detect thyroid cancer. Increasing usage of diagnostic scrutiny, including the ultrasound survey, has most likely contributed to the increased incidence through detection of small thyroid cancers. Increased use of ultrasound to screen thyroid cancer in early stages should lead to better therapeutic outcome.

Incidentally simultaneous occurrence of RET/PTC, H4–PTEN and BRAF mutation in papillary thyroid carcinoma

Because interaction existed between PTEN and RET-RAS-RAF-MAPK pathway, H4-PTEN (a newly identified gene rearrangement), RET/PTC and BRAF mutation were scanned in 125 Chinese patients with papillary thyroid carcinoma (PTC). H4-PTEN were detected in 9.6% of PTC and the frequency of the occurrence of BRAF mutation and/or RET/PTC in H4-PTEN positive tumors was extremely high (75%). On the other hand, age has an important effect on the aberration formation and young age renders more prone to multi-genetic events. A combinational scanning of these involved changes will improve the predictive value of molecular aberrations in the treatment of PTC.

Predictive index for lymph node management of major salivary gland cancer

To find the risk factors of lymph node (LN) metastasis of salivary gland cancer and draw a scheme for LN management.

miR-584 Suppresses Invasion and Cell Migration of Thyroid Carcinoma by Regulating the Target Oncogene ROCK1

Background: Uncovering the target gene of miR-584 to control thyroid carcinoma (TC) invasion and migration is of central importance in the diagnosis, treatment, and prognosis of TC. To validate whether miR-584 has a tumor-suppressive role in thyroid cancer cells by targeting ROCK1, a series of experiments were conducted to figure out the mechanism of action of miR-584. Material and Methods: Migration analyses and cell proliferation assays were performed using miR-584-transfected cells. The expression levels of miR-584 in TC were detected by using real-time polymerase chain reaction (PCR). Western blot analyses were conducted to find out the relationship between the tumor suppressor miR-584 and the target oncogene ROCK1 protein expression levels. Wound healing experiments were used to examine the relationships between miR-584 and the migration of thyroid cancer K1 cells and the effects of ROCK1 knockdown on K1 cell motility. Results: Our results demonstrate that altering the miR-584 levels affects human thyroid cancer cell migration, but has no effect on cell proliferation. The relative ROCK-1 expression levels were 1 and 0.54 in the scrambled-sequence control group and the miR-584 group, respectively. K1 cells transfected with siRNA-ROCK-1 showed weaker cell migration than cells transfected with siRNA-NC (negative control); the cell motility ratios were 18% and 27%, respectively. Conclusion: These results indicate that miR-584 could inhibit the expression of ROCK1, and ROCK1 knockdown would further affect the migration ability of K1 cells.

Extracranial schwannoma in the carotid space: A retrospective review of 91 cases

Schwannomas of the vagus nerve and cervical sympathetic nerve are rare; hence, only limited information exists regarding their diagnosis and clinical management.