甲状腺乳头状癌病理组织学亚型与颈淋巴结转移相关性探讨

目的: 分析探讨甲状腺乳头状癌的组织学亚型与颈淋巴结转移的相关因素。 方法: 对602例甲状腺乳头状癌患者各种病理组织学亚型发生颈淋巴结转移多种因素的相关性进行回顾性分析总结。 结果: 602例甲状腺乳头状癌共分成8个组织学亚型,颈淋巴结总转移率为65.0%(391/602),一般乳头(普通乳头)型、弥漫硬化型、包膜外型(包裹型侵出包膜)及滤泡亚型颈淋巴结转移率分别为72.4%(131/181)、75.2%(79/105)、80.3%(57/71)、73.0%(46/63),明显高于水肿乳头型(40.6%)(26/46)、高细胞型(46.2%)、微小型(47.8%)及包膜内型(30.0%)(P<0.01);颈部各区淋巴结转移率依次为Ⅲ区(49.5%)、Ⅳ区(42.3%)、Ⅱ区(38.5%)、Ⅵ区(30.2%)、Ⅴ区(8.9%)及Ⅰ区(1.6%)。 结论: 甲状腺乳头状癌颈淋巴结转移率与不同亚型密切相关。

The Relationship between Pathological Subtypes and Lymph Node Metastasis in Papillary Thyroid Carcinoma

Objective : To investigate the relationship between the pathological subtypes and cervical lymph nodemetastasis in papillary thyroid carcinoma. Methods : We retrospectively reviewed 602 cases of papillary thyroidcarcinomas who had underwent resection and neck lymph node dissection. χ² test was used to analyze thecorrelation between pathological subtypes and lymph node metastasis. Results : The total rate of cervicallymph node metastasis was 65% in these 602 cases. Among the 8 pathological subtypes, the rates of cervicallymph node metastasis were 72.4%, 75.2%, 80.3% and 73.0% in the subtypes of general papillary carcinoma,diffuse sclerosis variant, extracapsulated variant and follicle carcinoma, respectively. The rate of cervicallymph node metastasis was 40.6% in edematous carcinoma, 46.2% in tall cell carcinoma, 47.8% in minimalcarcinoma and 30.0% in intracapsulated variant. The frequently involved regions of lymph node metastasis inthe neck were region Ⅲ (49.5%), Ⅳ (42.3%), Ⅱ (38.5%) and Ⅵ (30.2%). Region Ⅴ (8.9%) and Ⅰ (1.6%)were in the minority. Conclusion : The rate of cervical lymph node metastasis is closely related to differentpathological subtypes in papillary thyroid carcinoma.