Objective: To investigate reasons for reoperation of papillary thyroid carcinoma (PTC) patients and the influential factors. Methods: The clinical data of 279 PTC patients undergoing reoperation from January 2007 to June 2016 were retrospectively analyzed. Results: Of the 297 patients, thyroid remnant cancer recurrence occurred in 156 cases (55.9%) and lymph node metastases occurred in 215 cases (77.1%), and the latter included central lymph node metastasis in 135 cases (48.4%) and lateral lymph node metastasis in 151 cases (54.1%). Statistical analyses showed that female gender and age≥45 years were independent risk factors for thyroid remnant cancer recurrence (both P<0.05); no central lymph node dissection (CND) and initial operation performed at a county-level hospital were independent risk factors for central lymph node metastasis (both P<0.05); male gender and total/near total thyroidectomy (TT/NTT) and CDN used as an initial procedure were independent risk factors for lateral lymph node metastasis (all P<0.05). The median recurrence time from the first operation was 33 months for patients undergoing the first operation at a hospital specialized in thyroid treatments, and they mainly had lateral lymph node metastasis (26.8%) and central lymph node metastasis (42.9%); it was 24 months in a province-level hospital, and they mainly had central lymph node metastasis (32.8%) and thyroid remnant cancer recurrence (29.9%); it was 24 and 12 months in a district- or prefecture-level and county-level hospital, and they mainly had thyroid remnant cancer recurrence of 36.7% and 45.9%, respectively. After reoperation, follow-up was obtained in 158 patients for 10 to 123 month, and of them, one case (0.4%) died, permanent hoarseness occurred in 7 cases (4.4%), permanent hypocalcemia occurred in 19 cases (12.0%), dedifferentiation after 131I therapy occurred in 9 cases (5.7%) and recurrence occurred in 22 cases (13.9%). Conclusion: Non-specialized operation and improper procedure are main reasons for increased postoperative thyroid remnant cancer recurrence and lymph node metastases and thereby reoperation in PTC. Lobectomy or TT/NTT plus ipsilateral or bilateral CND and/or combined with LND may effectively reduce the recurrence rates. The incidences of permanent surgical complications and dedifferentiation are higher after reoperation, so appropriate treatment should be taken in the initial treatment to reduce the risk of recurrence.

Objective: To investigate the clinicopathologic features of multifocal papillary thyroid microcarcinoma (PTMC) and the significance of prophylactic central neck dissection. Methods: The clinical data of 270 PTMC patients treated in the Department of Thyroid Surgery, Xiangya Hospital from July 2013 to December 2016 were reviewed. The differences in clinicopathologic factors between patients with multifocal PTMC and unifocal PTMC were compared, and the risk factors for central lymph node metastasis of multifocal PTMC were determined. Results: Among the 270 PTMC patients, multifocal PTMC was found in 120 cases (44.4%). In patients with multifocal PTMC, the proportion of male cases and the incidences of central lymph node metastasis and capsular invasion were significantly increased compared with patients with unifocal PTMC (both P<0.05). In multifocal PTMC patients, the maximum tumor diameter (5–10 mm vs.<5 mm), and the presence or absence of capsular invasion had significant impact on incidence of central lymph node metastasis (both P<0.05), while the lesion number (2 vs. ≥3) and distribution (unilateral lesion vs. bilateral lesion) showed no significant influence on incidence of central lymph nodes metastasis (both P>0.05). Conclusion: Compared to unifocal PTMC, multifocal PTMC has relatively poor clinicopathologic features and an increased risk of central lymph node metastasis. Prophylactic central lymph node dissection is necessary for multifocal PTMC patients, especially for those who have relatively large tumors and tumors with capsular invasion.

Objective: To investigate the clinical, ultrasonic and pathologic characteristic as well as treatment and outcomes of primary squamous cell carcinoma of thyroid (SCCT). Methods: The clinical presentations, ultrasonic features, pathologic findings and results of comprehensive treatment of 7 primary SCCT patients admitted from January 2010 to December 2015 were retrospectively analyzed. Results: The 7 primary SCCT patients accounted for 0.96% (7/728) of the total number of thyroid cancer patients admitted during the same period, of whom, 3 cases were male and 4 cases were female, with an average age of 62.7 years. All patients had palpable neck mass that was associated with dyspnea in 4 cases, hoarseness in 2 cases and dysphagia in one case. All lesions in ultrasonographic images presented as irregular mixed echogenic solid mass, with thyroid capsule penetration in 5 lesions, microcalcification in 2 lesions and suspicious cervical lymph nodes in 4 lesions. Five patients underwent surgical treatment (thyroidectomy with neck dissection in 2 cases, wide local excision in 2 cases, and palliative resection with prophylactic tracheostomy in one case), and 2 patients underwent coarse needle biopsy only. All cases were confirmed as SCCT by pathology, which was combined with nodular goiter in 3 cases and with papillary thyroid carcinoma in 2 cases, and the immunohisochemical staining for P63 was positive in all cases. Of the 5 patients undergoing surgical treatment, 4 cases had postoperative radiotherapy or radiotherapy plus chemotherapy, and one case did not receive comprehensive therapy; 2 patients undergoing coarse needle biopsy only received radiotherapy or radiotherapy plus chemotherapy. Only one patient who underwent thyroidectomy with neck dissection plus postoperative radiotherapy survived more than one year, and all the remaining patients died within half a year. Conclusion: Primary SCCT is a highly malignant tumor with rapid progress and poor prognosis. Its clinical manifestations and ultrasound imaging have certain characteristics that may help the preoperative diagnosis. Immunohistochemical staining is important for its differential diagnosis, and aggresive comprehensive treatment may improve the prognosis of the patients.

Objective: To investigate the value of using pectoralis major fascia in the immediate breast reconstruction following mastectomy for breast cancer. Methods: The clinical data of 18 patients with early breast cancer undergoing subcutaneous mastectomy with nipple-areola complex preservation and immediate breast reconstruction between May 2014 and September 2016 were retrospectively analyzed. All patients received breast reconstruction with prosthesis covered and wrapped by the pectoralis major muscle and its fascia, namely, firstly, the pectoralis major fascia was detached from the pectoralis major muscle, with a direction from the parasternal and infraclavicular region toward the lateral region, and then the prosthesis was implanted between the pectoralis major and minor muscles, and finally, the lateral border of the pectoralis major muscle was sutured to the detached pectoralis major fascia for firmly wrapping the prosthesis. Results: Breast reconstruction was successfully performed in all the 18 patients. During the follow-up period of 12 to 40 months, no recurrence or metastasis occurred in any of the patients, all reconstructed breasts displayed a natural shape and acceptable symmetry, no displacement or contracture of the breast prosthesis was noted, and the postoperative appearance good rate was 100%. Conclusion: For some early breast cancer patients, subcutaneous mastectomy with nipple-areola complex preservation plus immediate breast reconstruction using pectoralis major muscle and its fascia covering and wrapping the prosthesis is simple and easy to perform, with excellent cosmetic effect and few complications.

Objective: To investigate the clinical efficacy of endocrinotherapy in treatment of breast cancer patients with hormone receptor (HR)-negative primary lesion and HR-positive axillary lymph node metastases. Methods: Sixty-seven breast cancer patients with HR-negative primary lesion and HR-positive axillary lymph node metastases admitted from January 2011 to January 2016 were randomly designated to observation group (33 cases) and control group (34 cases). Patients in both groups received the same chemoradiotherapy regimen, while those in observation group were additionally given administration of tamoxifen (pre-menopausal patients) or letrozole (post-menopausal patients) after chemotherapy. The recurrence/metastasis and survival rates of the two groups of patients were compared. Results: All patients were followed up for 12 to 60 months, during which time, recurrence/metastasis occurred in 13 cases and death occurred in 7 cases in observation group, and recurrence/metastasis occurred in 19 cases and death occurred in 15 cases in control group. The incidence of recurrence/metastasis of the two groups showed no significant difference (P>0.05), while the rate of death due to recurrence/metastasis was significantly lower in observation group than that in control group (P<0.05). The 1-, 3- and 5-year disease-free survival (DFS) rate was 100%, 81.8% and 72.7% in observation group and was 100%, 58.8% and 47.1% in control group respectively; the 1-, 3- and 5-year overall survival (OS) rate was 100%, 90.9% and 81.8% in observation group and was 100%, 70.6% and 58.8% in control group. Both 3- and 5-year DFS and OS in observation group were significantly higher than those in control group (all P<0.05). Conclusion: Attention should be paid to the molecular classification of primary lesion and axillary lymph node metastasis in breast cancer patients. Postoperative endocrinotherapy may improve the survival and reduce the risk of death for breast cancer patients with HR-negative primary lesion and HR-positive axillary lymph node metastases.

Ultrasound is one of the conventional techniques for the clinical diagnosis of breast cancer. The ultrasonic features of breast cancer are diverse, and more information is needed to ensure its early diagnosis and assessment. So, the combination of the multimodal ultrasound technologies is particularly important for the diagnosis of breast cancer. Here, the authors summarized the recent progress of multimodal ultrasound technologies, including automated breast volume scanner, elastography, contrast-enhanced ultrasound, etc. These technologies are playing important roles in the diagnosis of breast cancer and may have more promising clinical prospects in the future.