原发癌灶定位与甲状腺微小癌颈侧区淋巴结转移关系研究

目的探究原发灶定位与甲状腺乳头状微小癌(PTMC)颈侧区淋巴结转移的关系;评估超声检查预测颈侧区淋巴结转移的准确率。方法回顾性分析2014年1月至2015年12月天津医科大学肿瘤医院收治的134例PTMC病人的临床资料;均行中央区淋巴结清扫+改良颈侧区淋巴结清扫。依据超声定位分组;分析癌灶位置与颈侧区淋巴结转移的关系。结果颈侧各分区淋巴结转移发生率分别为:Ⅱ区30.6%、Ⅲ区50.7%、Ⅳ区57.5%、Ⅴ区11.3%。癌灶位于中上极者颈侧区淋巴结转移发生率高于癌灶位于下极者(89.7% vs. 75.7%;P=0.038);靠近外侧者较内侧者更易出现颈侧区淋巴结转移(93.7% vs. 81.4%;P=0.049)。超声检查判定Ⅱ、Ⅲ、Ⅳ、Ⅴ区淋巴结转移的敏感度分别为43.9%、85.3%、85.7%、14.3%;特异度为91.4%、57.6%、35.1%、99.1%。超声预测Ⅲ、Ⅳ区淋巴结转移敏感度较高;Ⅱ、Ⅴ区淋巴结转移特异度较高。结论癌灶位置与甲状腺微小癌颈侧区淋巴结转移密切相关;超声可为临床确定颈侧区淋巴结的清扫范围提供依据。

Tumor location and lateral lymph node metastasis in papillary thyroid microcarcinoma

Tumor location and lateral lymph node metastasis in papillary thyroid microcarcinoma LIU Xiao-nan*，ZHANG Wen-chao. *Department of Thyroid and Breast Surgery, Tianjin 4th Center Hospital，Tianjin 300140，China
Corresponding author：ZHANG Wen-chao，E-mail：zwbeyond_999@sina.com
Abstract Objective To evaluate tumor location as a factor predicting lateral lymph node metastasis (LLNM) and to assess the accuracy of ultrasonography (US) in the diagnosis of LLNM. Methods The clinicopathological data of 134 patients with thyroid microcarcinoma admitted between January 2014 and December 2015 in Tianjin Medical University Cancer Hospital were collected，and the relationship between the location of cancer foci and lateral cervical lymph node metastasis was analyzed according to the ultrasonic localization and grouping. Results The incidence rates of lymph node metastasis in levels Ⅱ，Ⅲ，Ⅳ，Ⅴ were 30.6, 50.7, 57.5 and 11.3%, respectively. Tumors located in the superior/middle were prone to metastasize to the lateral lymph nodes than those located in the inferior portion (89.7% vs. 75.7%，P=0.038). Cases with exterior locations were more likely to have lateral cervical lymph node metastasis compared with those cases with interior, respectively（93.7% vs.81.4%，P=0.049）. The sensitivity values for US for the prediction of LLNM in levels Ⅱ，Ⅲ，Ⅳ，Ⅴ were 43.9%, 85.3%, 85.7% and 14.3%, and the corresponding specificity values were 91.4%, 57.6%, 35.1% and 99.1%. The ultrasonographic prediction of lymph node metastasis in Ⅲ and Ⅳ was highly sensitive，and the specificity in Ⅱ and Ⅴ was high. Conclusion The localization of primary carcinoma is correlated with lateral lymph node metastasis in papillary thyroid microcarcinoma，and ultrasound could provide a basis for clinical determination of the dissection range of lateral lymph node.