对甲状腺乳头状癌（PTC）的患者是否行预防性的中央区淋巴结清扫（pCND）是存在争议的。相比于其他恶性肿瘤而言，PTC患者有较好的整体生存率，但由于淋巴结的转移而导致局部复发也是治疗的一个难点。与颈侧区淋巴结转移不同，中央区淋巴结转移在术前评估中不易被发现，并且第1次 术后如中央区的病灶复发或残留可能需再次手术治疗，但是出现手术并发症的风险将增加。由于中央区淋巴结在位置上属于甲状腺切除术的区域内，所以行pCND可以减少复发的风险及再次手术的需要，但也需要衡量患者的风险及获益。笔者将通过长期的治疗效果来讨论pCND的优势及劣势，同时也将对pCND的合理性，单或双侧pCND的指征及常规行pCND和复发再手术的比较进行讨论。分子标志物在高危患者中的应用及患者术后生存质量的研究也有所提及。

Objective: To investigate the clinicopathologic characteristics of primary hyperthyroidism with concomitant thyroid cancer. Methods: The clinical data of patients with primary hyperthyroidism and concomitant thyroid cancer treated in Department of Thyroid Surgery in the First Hospital of Jilin University from January 2010 to August 2013 were retrospectively analyzed, and were also compared with data in the literature. Results: A total of 85 patients with primary hyperthyroidism underwent surgical treatment, and 31 cases had concomitant thyroid cancer. The preoperative diagnostic rate by clinical findings and neck ultrasound examination was 80.6% (25/31). After control of the symptoms of hyperthyroidism and thyroid function recovery was assured by examinations, all the 31 patients underwent surgical treatment by different procedures according to the patient’s specific condition, and all of them were successfully discharged from the hospital after surgery. No iatrogenic permanent recurrent laryngeal nerve injury or hypoparathyroidism occurred. The postoperative pathology showed that one case was medullary carcinoma and all the other 30 cases were papillary thyroid carcinoma; 17 cases (54.8%) had capsular invasion, and 9 cases (29.10%) had lymph node metastasis in central compartment, but there was no statistical difference in any pathological parameter compared with that of thyroid cancer alone, which was reported in the literature. Conclusion: The incidence of primary hyperthyroidism with concomitant thyroid cancer shows an increasing trend, and the importance of neck ultrasound examination should be emphasized in early diagnosis of this condition. Timely surgical treatment with an appropriate procedure after diagnosis may offer favorable outcomes.

Objective: To investigate the value of determination of the peripheral blood level of CD4+CD25+Foxp3+ regulatory T cells (Treg) in breast cancer patients. Methods: The percentage of CD4+CD25+Foxp3+Treg cells in CD4+ T cells in the peripheral blood from 74 breast cancer patients and 30 healthy controls were measured by flow cytometry. The relations of CD4+CD25+Foxp3+Treg cell level with the clinicopathologic factors and relevant immunohistochemical parameters of the breast cancer patients were analyzed. Results: The percentage of CD4+CD25+Foxp3+Treg cells in CD4+ T cells of breast cancer patients was higher than that of healthy controls [(9.15±2.24)% vs. (2.29%±1.36%)], and the difference had statistical significance (P<0.05). Statistical analyses showed that the peripheral blood level of CD4+CD25+Foxp3+Treg cells of breast cancer patients was significantly related to histological grade, lymph node metastasis, pTNM stage and expressions of HER-2, pS2 and nm23 (r=0.583, r=0.333, r=0.919, r=0.604, all P<0.05), and irrelevant to tumor size, pathological type and the expressions of estrogen receptor (ER), progesterone receptor (PR), p53 and Ki-67 (all P>0.05). Further correlation analyses demonstrated that CD4+CD25+Foxp3+Treg cell level was positively correlated with histological grade, number of lymph node metastasis, pTNM stage and Her-2 expression and negatively correlated with pS2 and nm23 expression (r=–0.229, r=-0.401, all P<0.05). Conclusion: The peripheral blood level of CD4+CD25+Foxp3+Treg cells is increased in breast cancer patients, which also is closely related to the progression and metastasis of breast cancer. So its determination may offer certain implications for evaluation of the prognosis and therapeutic effects of the patients.

Objective: To investigate the value of ultrasound detection of calcifications in differential diagnosis of benign and malignant thyroid nodules. Methods: The ultrasonographic data and clinicopathologic observations of 4 0 1 1 patients with thyroid disease undergoing surgical treatment from January 2005 to January 2010 were reviewed. The relations of whether or not calcification was present and different calcification patterns with benign and malignant thyroid nodules were analyzed, and the malignancy rate between single calcified nodule and multiple calcified nodules, and among calcified nodules of different ages groups were compared. Results: The malignancy rate in thyroid nodules with calcifications was significantly higher than that in those without calcification; in nodules with microcalcifications was signi?cantly higher than that with non-calci?cation; in single calcified or microcalcified nodule was significantly higher than in multiple calcified nodules; in calcified nodules in patients below 45 years old was significantly higher than that in those in patients greater than or equal to 45 years old, and all the difference had statistical significance (all P<0.05). For diagnosis of thyroid cancer, the sensitivity of calcification, microcalcification, macrocalcification and rim-like calcification was 80.42%, 51.65%, 26.52% and 2.25%, and their specificity was 67.53%, 93.19%, 76.79% and 97.55%, respectively. In the 39 patients with calcification in cervical lymph nodes, 37 cases were papillary thyroid carcinoma with lymph node metastases. Conclusion: Calcification and microcalcification in thyroid nodules has great importance in diagnosis of thyroid cancer. Single calcified nodule, microcalcified nodule, calcified nodules in patients younger than 45 years old, and calcification in lymph nodes have higher malignancy rate.

Objective: To investigate the clinicopathologic characteristics of breast cancer in women under 35 years of age. Methods: The clinical and pathological data of 85 young women (under 35 years of age) with breast cancer (observational group) admitted from 2005 to 2010 were retrospectively analyzed, and were compared with those from 164 middle-aged and elderly women with breast cancer (control group), who were admitted during the same period and randomly selected. Results: In the 85 young breast cancer women in observational group, there were no specific clinical symptoms, the misdiagnosis rate was 45.88%, average age was (30.27±2.41) years and average disease course was (11.51±1.56) months. Compared with control group, observational group showed larger tumor size, more advanced clinical stage, and poorer differentiation in histological grade (all P<0.05), but no statistical difference in constitution of the pathological types (P>0.05). In addition, the expression levels of estrogen receptor (ER) and progesterone receptor (PR) were lower but c-erbB-2 protein expression level was higher in the breast cancer tissues in observational group than those in control group (all P<0.05), and both rate and number of axillary lymph node metastasis in observational group were higher than those in control group (both P<0.05). Conclusion: Breast cancer in young women has distinct clinicopathologic characteristics and molecular biological features. Early diagnosis and treatment is the effective way to improve the survival rate in these patients.

Objective: To assess application value of bilateral water-dripping bipolar coagulation in hepatic lobectomy. Methods: The clinical data of 145 patients undergoing hepatic lobectomy in the first affiliated hospital of Chongqing Medical University between April 2011 and August 2013 were retrospectively analyzed. Of the patients, 93 cases underwent liver resection with bilateral water-dripping bipolar coagulation (observational group), and 52 cases received radiofrequency ablation (RFA)-assisted liver resection (control group). The clinical results of the two groups of patients were compared. Results: The preoperative data between the two groups were comparable, and all patients successfully received hepatic lobectomy. In observational group compared with control group, the operative time was prolonged, but the surgery-related cost and overall incidence of postoperative complications were significantly reduced (all P<0.05). There was no statistical difference between the two groups in terms of rate of first hepatic portal occlusion, intraoperative blood loss, transfusion rate, function recovery or length of postoperative hospital stay (all P>0.05). Conclusion: Hepatic lobectomy using bilateral water-dripping bipolar coagulation has the advantages of decreased postoperative complications and surgery-related cost, so it is recommended for use.