甲状腺乳头状癌淋巴结转移的风险因素分析

目的探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的临床病理学特征及淋巴结转移的风险因素。方法收集504例PTC手术标本,回顾性分析患者的临床资料及病理特点,通过单因素和多因素分析淋巴结转移的危险因素。结果(1)中央区淋巴转移中男性(47.58%)、年龄45岁(43.49%)、合并结节性甲状腺肿(46.20%)的患者转移率均显著增高;侧颈区淋巴结转移中男性(32.26%)、肿瘤最大径 1 cm(26.08%)、多发病灶(28.64%)、合并结节性甲状腺肿(32.28%)及合并淋巴细胞性甲状腺炎(36.73%)、双侧病变(33.08%)的患者转移率均显著增高。多因素分析显示,患者性别、结节性甲状腺肿是中央区淋巴结转移的独立危险因素;患者性别、肿瘤最大径、结节性甲状腺肿及病变位置(单/双侧)是侧颈区淋巴结转移的独立危险因素。(2)单因素分析显示,多个淋巴结转移中肿瘤最大径 1 cm(14.35%)、伴钙化(24.24%)、合并结节性甲状腺肿(18.35%)及合并淋巴细胞性甲状腺炎(28.30%)、双侧病变(17.78%)的患者转移率均显著增高。多因素分析显示,肿瘤最大径、合并淋巴细胞性甲状腺炎及结节性甲状腺肿是多个淋巴结转移的独立危险因素。结论 PTC患者的性别、年龄、肿瘤直径等临床病理学特征是淋巴结转移的危险因素,有望成为临床术前或术中诊断PTC依据,为制定合理的治疗方案提供帮助。     

甲状腺乳头状癌颈部Ⅱb区淋巴结转移特点及相关因素分析

目的探讨甲状腺乳头状癌颈部Ⅱb区淋巴结转移规律及相关因素分析。方法回顾性分析2006年1月至2013年1月在广西医科大学附属肿瘤医院接受患侧同期颈淋巴结清扫术的甲状腺乳头状癌患者的临床资料,共纳入能够获得Ⅱa、Ⅱb、Ⅲ、Ⅳ、Ⅴ及Ⅵ区淋巴结转移情况的病人资料共61例,其中3例为双侧甲状腺乳头状癌伴双侧颈部淋巴结转移,共计算64侧颈各区淋巴结转移率,并分析各个临床指标,包括性别、年龄、T分期、颈部各区淋巴结转移率等与11b区转移的相关性。结果61例病人,共64侧颈Ⅱ、Ⅲ、Ⅳ、Ⅴ及Ⅵ区淋巴结转移率分别为34．4％（22／64）、43．8％（28／64）、42．2％（27／64）、25．0％（16／64）和48．4％（31／64）,其中Ⅱa和Ⅱb区淋巴结转移率分别是25．0％（16／64）和9．4％（6／64）。多因素分析显示Ⅱa区淋巴结转移是Ⅱb区淋巴结转移的独立危险因素。结论甲状腺乳头状癌颈部Ⅱb区淋巴结转移率较低,如果出现Ⅱa区淋巴结转移则Ⅱb区应行常规清扫。     

颈中央区淋巴结数目及分布的临床解剖学研究

目的　探讨颈中央区淋巴结的数目及分布规律。 方法　回顾分析2013年6月-2016年6月在我科行中央区淋巴结清扫术的甲状腺乳头状癌患者的临床资料。统计分析颈部中央区及各亚区淋巴结的数目。 结果　双侧中央区淋巴结(9.86±3.36) 枚（4~20枚）。左侧中央区淋巴结(6.24±2.23) 枚（2~14枚）。右侧中央区淋巴结(7.77±2.79) 枚（2~15枚）。喉前区淋巴结(1.29±0.75) 枚（0~4枚）,气管前区(2.62±1.26) 枚（0~7枚）,左侧气管旁区(2.38±1.34) 枚（0~6枚）,右侧气管旁区(3.97±1.97) 枚（0~10枚）。四个亚区淋巴结比例分别为：12.69%,24.47%,24.15%,38.47%。其中右侧气管旁区的两个亚区右侧喉返神经外侧区(1.35±1.27) 枚（0~6枚）,右侧喉返神经内侧区(2.64±1.75) 枚（0~9枚）。 结论　本研究报道颈中央区淋巴结的数目及分布结果,可为外科医生在行颈中央区淋巴结清扫术时提供解剖学依据。     

甲状腺乳头状癌合并桥本氏甲状腺炎右侧喉返神经深层淋巴结转移情况分析

目的:探讨甲状腺乳头状癌(PTC)合并桥本氏甲状腺炎(HT)患者右侧喉返神经深层淋巴结(LN-prRLN)的转移情况.方法:选取本院2015年7月至2019年12月收治的123例PTC合并HT及150例单纯PTC病例为研究对象,分为观察组、对照组.所有患者均行中央区淋巴结完整清扫,比较2组颈部中央区淋巴结转移情况,分析...     

1例左侧甲状腺乳头状癌伴左颈部淋巴结转移的临床分析

甲状腺乳头状癌是最常见、恶性度相对较低的癌。该肿瘤生长缓熳,可在甲状腺内局限数年不变,其病灶也可经腺内的淋巴管从原发部位扩散至腺体其他部位和局部淋巴结（多见于颈部淋巴结）,当甲状腺乳头状癌伴左颈部淋巴结转移时,其机体会出现明显的异常病症,严重时会导致病患全身淋巴结出现病症和变异,甚至死亡。本文就左侧甲状腺乳头状癌伴左颈部淋巴结转移的临床特点,作出了相关的探讨与观察,现报告如下。     

甲状腺乳头状癌颈部淋巴结转移特点及相关危险因素分析

目的 探讨甲状腺乳头状癌（PTC）临床病理特征及影响颈部淋巴结转移的危险因素。方法 回顾性分析我院2015年1月~2017年12月收治的515例PTC的临床资料,分析颈部淋巴结转移特点及相关危险因素。结果 PTC颈部淋巴结转移率为44.27%,中央组（Ⅵ区）淋巴结转移率高于侧区（P＜0.05）。单因素分析结果示性别、年龄、多灶、癌灶最大径、侵犯被膜和颈部淋巴结转移有关（P＜0.05）。多因素分析结果示男性、年龄＜55岁、多灶病变、癌灶最大径＞10 mm、被膜受侵犯是发生颈部淋巴结转移的独立危险因素（P＜0.05）。结论 Ⅵ区转移率最高,行颈淋巴结清扫时应将Ⅵ区作为常规清扫区域。对于男性、年轻、多灶病变、癌灶最大径＞10 mm、被膜受侵犯的患者应高度警惕颈部淋巴结转移的可能。     

颈侧清扫术与颈改良根治性清扫术在喉癌cN1治疗中的应用

目的:对比分析颈侧清扫术(lateral neck dissection,LND)与改良根治性颈清扫术(modified neck dissection,MND)在治疗喉癌临床N1(clinical N1,cN1)患者中的效果.方法:回顾性分析51例伴cN1期颈淋巴结转移的喉癌患者的临床资料,Kaplan-Meier法统计累积生存率,Log-rank检验比较LND组(37例)和MND组(14例)的生存率.结果:LND组和MND组的5年生存率分别为89.2%和85.7%(P＞0.05);5年颈淋巴复发率分别为2.7%和0%(P＞0.05);而LND组与颈清扫有关的并发症的发生率为8.1%,明显低于MND组的42.9%(P＜0.01);两组的平均住院时间为25 d和32 d(P＜0.05).结论:与改良根治性颈清扫术相比,采用颈侧清扫术不影响cN1喉癌患者的疗效,同时降低了并发症的发生率,缩短了住院时间.     

Focus超声刀在下咽癌及颈淋巴结清扫术中的临床应用价值

目的探讨Focus超声刀在下咽癌及颈淋巴结清扫术中的临床应用价值。方法回顾性分析2009年1月—2013年12月安徽医科大学第一附属医院耳鼻咽喉头颈外科同一手术组完成的59例下咽癌手术的临床资料,其中采用Focus超声刀进行切割、止血26例(超声刀组),采用电刀及传统结扎、缝合手术33例(传统组)。比较两组手术时间、术中出血量、颈部淋巴结清扫数目、术后24 h引流量、术后住院时间及手术并发症发生情况。结果超声刀组手术时间、术中出血量、术后24 h引流量及术后住院时间分别为(193.69依43.16) min、(82.85依14.04) mL、(54.46依8.17) mL、(15.00依5.70)d,传统组分别为(303.27依26.24) min、(132.85依10.83) mL、(94.82依13.04) mL、(22.79依12.45)d,两组比较差异均有统计学意义(t值分别为11.393、15.454、14.522、3.193, P值均<0.01)。两组颈部淋巴结清扫数目及手术并发症发生率差异均无统计学意义(P值均>0.05)。结论用Focus超声刀行下咽癌及颈淋巴结清扫术安全可靠,具有创伤小、术中出血少、不影响颈部淋巴结清扫数目、手术时间短、术后渗出少及痊愈快的优势,值得临床推广应用。     

甲状腺乳头状癌 ALDH1A1表达与淋巴结转移的相关性

目的探讨甲状腺乳头状癌（ PTC）中ALDH1A1的表达情况及与淋巴结转移的相关性。方法收集首都医科大学附属北京同仁医院病理科2006年1月至2013年12月间PTC腺叶切除＋淋巴结清扫标本153例,在HE染色下观察其一般临床病理学特点（肿物直径、双侧、多灶、肿瘤边界、腺叶外浸润）,并采用免疫组织化学染色EnVision法,检测癌及癌旁组织中ALDH1A1的表达情况,分析ALDH1A1表达与淋巴结转移的关系。结果在153例PTC中,84例（54.9％）发生淋巴结内癌转移,126例癌组织高表达ALDH1A1,112例癌旁组织高表达ALDH1A1。通过单因素分析,发现年龄＜45岁、肿物直径＞10 mm、浸润性边缘及癌组织 ALDH1A1高表达与淋巴结转移明显相关（P＜0.05）。而性别、双侧、多灶、腺叶外浸润、癌旁组织ALDH1A1与淋巴结转移无关（P＞0.05）。进一步多因素分析发现浸润性边界和癌组织ALDH1A1高表达是PTC淋巴结转移的独立危险因素（P＜0.05）。在随访的82例PTC中,局部肿瘤复发4例,5年局部复发率为4.88％,包括淋巴结肿瘤复发3例和甲状腺肿瘤复发1例,无远处转移及疾病相关死亡病例。复发病例肿瘤组织ALDH1A1均为高表达。结论 ALDH1 A1在PTC癌组织内高表达与淋巴结转移明显相关,可作为PTC淋巴结转移的有效预测因子,有利于改善PTC患者治疗方法及随访方案。     

Correlation analysis on central lymph node metastasis in 276 patients with cN0 papillary thyroid carcinoma

Objective: To explore the relationship between sex, age, capsule invasion, tumor size, tumor location, number and central lymph node metastasis. Methods: Correlation analysis was conducted on clinical data of 276 patients with cN0 papillary thyroid carcinoma who underwent central lymph node dissection. Results: There was significant difference between patients less than 45 years old and greater than or equal 45 years old (P<0.05), between patients with capsule invasion and without capsule invasion (P<0.05); there were significant differences in the central lymph node metastasis rate between group with Φ≤0.5cm as well as Φ>2cm and the other three groups (P<0.05), and there was significant difference between upper pole group and middle/lower pole group (P<0.05) while no significant difference was found between middle pole and lower pole (P>0.05); there was also no significant difference in the central lymph node metastasis rate between groups with 1 tumor and greater as well as equal 2 (P>0.05). Conclusion: We considered the tumor located in middle and lower pole, Φ>0.5cm of tumor size, less than 45 years old and the present of capsule invasion were high risk factors of central lymph node metastasis, so we strongly recommend performing central lymph node dissection in synchronization.     

Risk factors for predicting central lymph node metastasis in papillary thyroid microcarcinoma

Objectives: We aimed to determine the predictive factors for central compartment lymph node metastasis (LNM) in papillary thyroid microcarcinoma (PTMC). The outcome of the current study could assist greatly in decision-making regarding further treatment. Methods: Retrospective analysis of PTMC treated at the First Affiliated Hospital of Harbin Medical University. The predictive risk factors for central lymph node metastases (CLNM) were analyzed with respect to age, sex, tumor size, multifocal and capsular affection. Results: CLNM are common in thyroid microcarcinoma patients. The factors correlated with neoplasm size greater than 5 mm (odds ratio, 0.520; P = 0.001), tumor bilateral (odds ratio, 0.342; P = 0.020), and capsule invasion (odds ratio, 2.539; P = 0.000) were independently predictive of CLNM. In patients with a solitary primary tumor, tumor location in the lower third of the thyroid lobe was associated with a higher risk of CLNM. Conclusions: The risk factors such as male gender, tumor size > 5 mm, bilateral, multifocal location, lower third of the thyroid lobe and capsule invasion that can be identified preoperatively or intraoperatively, be considered for determination of prophylactic CLND in patients with PTMC.     

Histopathologic and immunohistochemical characterization of a primary papillary thyroid carcinoma in the lateral cervical lymph node

Lymph nodes in the neck are known to occasionally contain benign epithelial inclusions and can be rare primary site of various tumors usually occurring in other organs. Papillary thyroid carcinoma in the lateral neck lymph node with co-existing ectopic thyroid inclusions has not been reported previously. A 41-year-old male patient, who had normal thyroid function and no history of neck irradiation, was seen with a slowly enlarging mass in the right lateral neck. At surgery the cervical mass was found to be separate from the thyroid proper without any attachments in between. Papillary thyroid carcinoma and co-existing thyroid inclusions were identified within the lateral cervical lymph node. Immunohistochemistry detected strong and diffuse cytoplasmic positivity with antibodies against CK19 and CK903 in papillary thyroid carcinoma. Benign thyroid follicles within the lymph node were only weakly and focally stained. Thorough examination confirmed no malignancy in the total thyroidectomy specimen. Furthermore, small foci of metastatic papillary carcinoma were identified in two ipsilateral lymph nodes from neck dissection specimen. These findings suggest development of primary papillary thyroid carcinoma from malignant transformation of benign intranodal thyroid inclusions.     

Impact of clinicopathologic factors on subclinical central lymph node metastasis in papillary thyroid microcarcinoma

Purpose: We evaluated whether the clinicopathological factors of papillary thyroid microcarcinoma (PTMC), especially tumoe size, are associated with subcinical central lymph node metastasis. Materials and Methods: A total of 160 patients diagnosed with PTMC who underwent total thyroidectomy with bilateral central lymph node dissection were enrolled in this study. All patients were clinically lymph node negative PTMC. Patients were divided into 2 groups according to the size of tumor (≤5 mm vs. >5 mm). Clinicopathologic risk factors for subclinical central lymph node metastasis were analyzed. Results: Subclinical central lymph node metastasis was detected in 61 (38.1%). Patients with tumors ≤5 mm had a lower frequency of extrathyroidal extension, multifocality and subclinical central lymph node metastasis. On multivariate analysis, only male and tumor size >5 mm were independent predictors of subclinical central lymph node metastasis; age, multifocality, bilaterality, extrathyroidal extension, lymphvascular invasion and lymphocytic thyroiditis were not. Conclusion: In this study, male and tumor size >5 mm were two independent predictive factors for subclinical central lymph node metastasis in PTMC. These are easier factors to assess before surgery than other factors when planning the central lymph node dissection. However, further long-term follow-up studies are needed to confirm the prognostic significance of subclinical central lymph node metastasis in PTMC.     

分化型甲状腺癌侧颈部淋巴结转移特点及诊疗技术研究进展

目的:总结分化型甲状腺癌(DTC)侧颈部淋巴结转移的特点及诊疗技术研究进展。方法:以"分化型甲状腺癌""颈部淋巴结转移""侧颈淋巴结转移""颈淋巴结清扫术""侧颈淋巴结清扫术""differentiated thyroid cancer""cervical lymph node metastasis""lateral ...     

Risk factors for central lymph node metastasis of patients with papillary thyroid microcarcinoma: a meta-analysis

Objective: To evaluate the risk factors of central lymph node metastasis of papillary thyroid microcarcinoma. Method: Published articles about papillary thyroid microcarcinoma were searched in PubMed, MEDLINE and EMBASE until October 2013 to examine the risky factors of central lymph node metastasis. Software RevMan 5.0 was used for meta-analysis. Results: Within the patients suffering papillary thyroid microcarcinoma underwent thyroidectomy plus prophylactic central lymph node dissection, tumor size, multifocality and capsular invasion have statistically relevant association with central lymph node metastasis, but no relation was observed associated with sex and age. Conclusion: The papillary thyroid microcarcinoma should be considered central lymph node metastasis when tumor size ≥0.5 cm, multifocality and have capsular invasion.     

Serum vascular endothelial growth factor-D levels correlate with cervical lymph node metastases in papillary thyroid carcinoma

The aim of this multicenter study was to evaluate the clinical relevance of serum vascular endothelial growth factor-D (VEGF-D) in papillary thyroid carcinoma (PTC). This prospective study consisted of 74 patients with primary PTC and 15 patients with benign thyroid nodules treated from 2008 to 2009. VEGF-D concentration was compared with patient clinicopathologic features and lymph node metastases. There was no significant difference in mean serum VEGF-D levels between the PTC and benign thyroid nodule groups. Within the PTC group, serum VEGF-D levels were significantly higher in patients with lymph node metastases than in patients without metastases (241.92 vs. 213.89 pg/ml, respectively; P = 0.035). Receiver operating characteristic curve analysis revealed that preoperative serum VEGF-D levels were predictive of lymph node metastases in the patients >45 years. Serum VEGF-D level that was correlated with the presence of cervical lymph node metastases in PTC patients might be a useful prognostic indicator.     

Pattern of nodal involvement in papillary thyroid cancer: a challenge of quantitative analysis

Introduction: Backgrounds of this study were to examine and analyse the relationship among the number of lymph nodes with metastases harvested in central and lateral compartments, the characteristics of tumours and patients, and the recurrences rate. Methods: A retrospective review of 118 patients treated for a papillary thyroid cancer and underwent to neck dissection, including in all cases both central and lateral compartment, was realised. A quantitative analysis, on this homogeneous cohort of patients, was performed to hypothesize the minimum number of cervical lymph nodes to be necessarily excised in order to obtain an adequate management of these patients. Results: The mean follow-up time was 75.9 months. Five-year overall survival was 96.6%. The correlation among the metastatic lymph node number of the ipsilateral central compartment, isolated or pooled with those of the ipsilateral lateral compartment, age of patient and tumour size revealed a statistical significance (P=0.01); both parameters, tumour size and age, may be considered as dependent predictor variables. Conclusion: We suppose, notwithstanding the limited number of patients, that the number of lymph nodes harvested to achieve an optimal cervical dissection may be superior to 8 and 11 in central and lateral compartments, and 6 and 10 in contralateral ones, respectively. Moreover we recommend the bilateral dissection of central nodes compartment in presence of tumour localised in the isthmus.     

Papillary thyroid carcinoma with anaplastic transformation showing a rhabdoid phenotype solely in the cervical lymph node metastasis

We describe a rare case of anaplastically transformed papillary thyroid carcinoma with a rhabdoid phenotype appearing solely in a metastatic focus. A 77-year-old man presented with a rapidly enlarging, painful right lateral cervical mass. CT scan revealed a tumor in the right upper pole of the thyroid gland and a right lateral cervical mass. Examination of surgically resected specimens disclosed that the thyroid tumor was a well-differentiated papillary carcinoma (2.0 cm in diameter), and the right lateral cervical mass was an anaplastic carcinoma (2.4 cm in diameter) showing a rhabdoid phenotype with scant amounts of a papillary carcinoma component in the periphery, considered to be transformed through the metastasis of the papillary thyroid carcinoma in a cervical lymph node. The rhabdoid cells had eccentric nuclei with conspicuous nucleoli and spherical hyaline cytoplasmic inclusions, which are immunoreactive for vimentin and sarcomeric actin. Ultrastructurally, these had globular aggregation of thin and intermediate filaments. Nuclear immunoreactivity for INI1 indicated that the tumor had no INI1 abnormalities, suggesting a secondary rhabdoid tumor. Recurrence developed in the right cervical and mediastinal lymph nodes, and the patient died of disease 6 months after surgery. A rhabdoid phenotype is a pathological hallmark indicating the aggressive nature not only in the neck region, but also in other organs.