Lymphovascular invasion is associated with lateral cervical lymph node metastasis in papillary thyroid carcinoma

OBJECTIVES: The objective of this retrospective study to evaluate whether lymphovascular invasion (LVI) is associated with lateral cervical lymph node metastasis and tumor recurrence in papillary thyroid carcinoma (PTC). METHODS: We evaluated the medical records of patients with PTC who had undergone total thyroidectomy and subsequent I remnant ablation at Asan Medical Center, Seoul, Korea, from January 1997 thorough December 2000. RESULTS: A total of 662 patients (585 women and 77 men; mean age, 44.8 years) with PTC were enrolled in the study. Of these patients, 33 were found to have LVI. We found a significant association between LVI and lateral cervical lymph node metastasis at the time of initial surgery (P = .001). Multivariate analyses adjusting for clinicopathologic parameters known to predict recurrence such as age, gender, tumor size, extrathyroid extension, and multifocality also showed a significant association between LVI and lateral cervical lymph node metastasis. For the 633 patients without distant metastasis at the time of initial surgery, LVI was also significantly associated with tumor recurrence during the follow-up period (median, 68 months; range, 3-108 months): 29% versus 13.6% for patients with and without LVI, respectively (P = .048 by log-rank test). However, this association was lost on multivariate analyses adjusting for conventional clinicopathologic predictors of recurrence. CONCLUSIONS: In patients with PTC, LVI is associated with lateral cervical lymph node metastasis and clinical recurrence.     

甲状腺乳头状癌颈部淋巴结转移规律及影响因素分析

目的：探讨甲状腺乳头状癌颈部淋巴结转移规律及其相关影响因素,为甲状腺乳头状癌颈部淋巴结清扫术提供一定的临床依据。方法：回顾性分析314例甲状腺乳头状癌患者的临床资料。314例患者中,行甲状腺腺叶峡部切除、中央区淋巴结清扫术79例,甲状腺全切、中央区淋巴结清扫术173例,甲状腺全切、中央区淋巴结清扫术、侧颈部改良根治性颈部淋巴结清扫术62例。手术中清扫出淋巴结1～55个,其中阳性淋巴结0～14个。结果：314例患者中经病理证实共有168例（53．50％）患者有淋巴结转移,其中中央区淋巴结转移159例（50．64％）,中央区＋侧颈转移淋巴结55例（17．52％）,单纯侧颈淋巴结转移9例（2．87％）。患者年龄、肿瘤直径、甲状腺被膜受侵犯、临床分期是甲状腺乳头状癌颈部淋巴结转移的影响因素（P〈0．05）。结论：甲状腺乳头状癌患者最常发生中央区淋巴结转移,应常规进行中央区淋巴结清扫术。     

甲状腺乳头状癌患者甲状腺肿瘤特征对颈侧区淋巴结转移的影响

目的 研究甲状腺乳头状癌患者甲状腺肿瘤特征对颈侧区淋巴结转移的预测作用。方法 回顾性分析2017年1月—2020年12月手术治疗的甲状腺乳头状癌患者的临床资料509例,男105例,女404例;年龄18~85岁,平均(45.38±14.85)岁。其中临床分期Ⅰ期382例,Ⅱ期127例。采用多因素二元Logistic回归分析甲状腺乳头状癌患者颈侧区淋巴结转移的影响因素。结果 根据病理诊断结果是否存在颈侧区淋巴结转移,其中178例患者存在颈侧区淋巴结转移,331例患者不存在颈侧区淋巴结转移。存在颈侧区转移和不存在颈侧区转移的患者临床资料比较发现,存在颈侧区转移的患者中年龄<40岁、肿瘤最大直径>2 cm、转移中央区淋巴数量>5个、多灶性以及鼠类肉瘤滤过性毒菌致癌基因同源体B1(v-raf murine sarcoma viral oncogene homolog B1,BRAF)不存在突变的患者比例显著高于存在颈侧区转移的患者(P<0.05)。采用多因素二元Logistic回顾分析结果发现肿瘤最大直径>2 cm (OR=3.482,95%CI:1.482~5.642,P=0.000)、转移中央区淋巴结数量>5个(OR=6.583,95%CI:2.384~12.373,P=0.000)、多灶性(OR=3.473,95%CI:1.387~8.684,P=0.032)以及BRAF不存在突变(OR=3.952,95%CI:1.489~9.572,P=0.000)是甲状腺乳头状癌发生颈侧区淋巴结转移的独立危险因素。结论 肿瘤最大直径>2 cm、转移中央区淋巴数量>5个、多灶性以及BRAF不存在突变是甲状腺乳头状癌患者出现颈侧区淋巴结转移的独立危险因素。     

Predictive factors for central compartment lymph node metastasis in thyroid papillary microcarcinoma

OBJECTIVE: We examined the incidence of nodal involvement and attempted to determine the predictive factors for central compartment lymph node (LN) metastasis in thyroid papillary microcarcinoma (PMC). STUDY DESIGN: Retrospective chart review. METHODS: We undertook a retrospective study of 52 patients treated between January 2000 and December 2005 for PMC by total thyroidectomy and elective central compartment LN dissection with or without comprehensive lateral neck dissection (n = 9). There were 45 women and 7 men whose mean age was 47.6 +/- 11.5 years. The following criteria were used to study the predictive value of central compartment LN metastasis: sex, age, multifocality of the tumor, extracapsular spread (ECS), the involvement of the lateral neck LN, tumor size, and tumor location. RESULTS: In 16 of 52 (31%) patients, central compartment LN metastasis was found. With use of univariate and multivariate analysis, ECS, lateral LN metastasis, and tumor size (>5 mm) were independent correlates of central compartment metastasis. Sex, age, multifocality, and tumor location were not associated with central compartment LN metastasis and did not significantly influence the predictive value of these variables. CONCLUSIONS: We found a significant association among ECS, lateral LN metastasis, tumor size (>5 mm), and central compartment LN metastasis in patients with PMC. A prophylactic neck dissection of the central compartment should be considered particularly in patients with ECS of the tumors, metastatic LN in the lateral neck, and a greater than 5 mm tumor size.     

甲状腺微小乳头状癌行中央区淋巴结清扫的必要性探究

目的：分析甲状腺微小乳头状癌发生中央区淋巴结转移的危险因素,探讨中央区淋巴结清扫的必要性。方法：回顾2004—01—2012—05期间手术治疗的85例甲状腺微小乳头状癌患者的临床资料,通过单因素及多因素分析,明确中央区淋巴结转移的危险因素,为选择性地进行中央区淋巴结清扫术提供依据。结果：85例患者均接受了中央区淋巴结清扫术,其中同侧中央区清扫者66例,双侧中央区清扫者19例。3例同期行颈部淋巴结清扫术。33例（38．8％）发生中央区淋巴结转移,3例（3．53％）发生颈侧区淋巴结转移。单因素分析显示：不同性别、年龄组中央区淋巴结转移差异无统计学意义（P〉0．05）;肿瘤直径大于5mm、甲状腺外侵犯、多中心病灶、双侧病灶及术中探及中央区可疑阳性巴结者,发生中央区淋巴结转移的比例明显增高（P〈0．05）。多因素分析显示：肿瘤直径大于5mm（OR=3．862,P〈0．05）、甲状腺外侵犯（OR=3．885,P〈0．05）是发生中央区淋巴结转移的独立危险因素。结论：甲状腺微小乳头状癌患者肿瘤直径大5mm和（或）甲状腺外侵犯时,发生中央区淋巴结转移的危险性增加,有必要行中央区淋巴结清扫术。     

甲状腺乳头状癌颈部淋巴结转移规律的临床分析

目的 探讨甲状腺乳头状癌颈淋巴结转移规律,为选择最佳手术方式提供参考。方法 回顾分析2001年1月至2013年8月济南军区总医院甲状腺乳腺外科616例诊断为甲状腺乳头状癌患者的临床和病理资料。结果 616例有完整统计资料的甲状腺乳头状癌患者中,病理诊断颈部淋巴结总转移率为58.77%(362/616),中央区(Ⅵ区)淋巴结转移率为48.70%(300/616),颈侧区(Ⅱ、Ⅲ、Ⅳ、Ⅴ区)淋巴结转移率为38.80%(239/616),原发肿瘤的部位、最大直径、是否累及包膜、是否为多发病灶及患者年龄对颈部淋巴结转移率有显著影响,差异有统计学意义(P＜0.05),且双因素方差分析显示,肿瘤直径越大,转移到颈侧区的可能性越大。结论 甲状腺乳头状癌最常见的转移部位是Ⅵ区,术中应常规清除,其次依次为Ⅲ、Ⅳ、Ⅱ、Ⅴ区,对于患者原发肿瘤具有累及包膜、直径＞1cm、多发病灶及位于双侧等特点应清扫颈侧区,术中快速病理检查颈侧区淋巴结病理状态,确定颈侧区淋巴结清扫范围。     

甲状腺乳头状癌Ⅵ区淋巴结清扫非劣性研究

目的：了解未行含Ⅵ区的择区性淋巴结清扫术的分化良好的甲状腺乳头状癌患者的复发情况;探讨分化良好的甲状腺乳头状癌是否要常规行含Ⅵ区的择区性颈淋巴结清扫术。方法：不同时期处理的甲状腺乳头状癌患者267例,按时间分成2组：A组为近期行含Ⅵ区的择区性淋巴结清扫的甲状腺乳头状癌151例;B组为早期未行Ⅵ区择区性淋巴结清扫的甲状腺乳头状癌116例。原发灶处理2组均一致：肿瘤发生侧行甲状腺全切除,甲状腺峡部全切,健侧甲状腺次全切除;若肿瘤两侧同时发生,则行双侧甲状腺全切术。统计第1组中Ⅵ区淋巴结转移发生率;随访第2组患者,观察头颈部淋巴结复发情况以及生存情况。结果：A组151例患者中59例仅行Ⅵ区淋巴结清扫,其中发生转移者22例,其余92例同时行Ⅱ、Ⅲ、Ⅳ、Ⅵ区颈淋巴结清扫,其中各区都没有转移者31例,Ⅵ区和其他区均转移者33例（35．8％）,只有Ⅵ区颈淋巴结转移者17例（18．4％）,除Ⅵ区外其他区域淋巴结有转移者11例（11．9％）。即甲状腺乳头状癌病例中Ⅵ区淋巴结转移率为47．7％（72／151）。B组116例甲状腺乳头状癌伴有颈淋巴结转移者47例,占40．5％;5年生存率为99．3％;复发率为6．0％（7／116）。A组颈淋巴结转移率（54．9％）高于B组（40．5％）。结论：分化良好的甲状腺乳头状癌患者较多的转移到气管前和喉返神经周围淋巴结,Ⅵ区淋巴清扫可成为常规。     

Reliable sonographic features for nodal thyroglobulin to diagnose recurrent lymph node metastasis from papillary thyroid carcinoma

Objectives

Ultrasound‐guided aspiration cytology (US‐FNAC) was previously used to diagnose lymph node metastasis of papillary thyroid carcinoma (PTC). Combined US‐FNAC with nodal thyroglobulin (LN‐FNA‐Tg) significantly improved the diagnostic rate. However, diagnostic accuracy depends on proper node selection. Therefore, it is crucial to choose the nodes with reliable sonographic features to guide clinician for confirmation.

Design and Setting

Retrospective cohort study was carried out in one medical centre from 2011 to 2014.

Participants

A total of 148 patients with PTC, being treated by total thyroidectomy and radioiodine, were assessed for potential nodal metastases by ultrasound.

Main outcome measures

Lymph nodes with cystic content, peripheral hypervascularity, calcification, hyperechoic content, the absence of hilum and Solbiati index < 2 indicated risk of malignancy. US‐FNAC and LN‐FNA‐Tg were both performed. Positive nodal metastasis was further confirmed by dissection. Risk impact of these sonographic features on LN‐FNA‐Tg to diagnose nodal metastasis was tested by logistic regression analysis based on the significance in both univariate and multivariate models.

Results

Overall, 49 lymph nodes were documented as recurrent nodal metastasis. LN‐FNA‐Tg greater than serum thyroglobulin and higher than 1 ng/mL achieved 100% of diagnostic rate for recurrent nodal metastasis. The malignant sonographic features that significantly cohered with positive LN‐FNA‐Tg were cystic and hyperechoic content and lack hilum, in sequence.

Conclusions

LN‐FNA‐Tg is an excellent tool to quantitatively diagnose nodal metastasis. To achieve ideal diagnosis, the most reliable sonographic features were cystic content, hyperechoic content and the absence of hilum in lymph nodes, but not calcification or Solbiati index < 2.     

临床淋巴结阴性甲状腺微小乳头状癌患者中央区淋巴结转移危险因素分析

目的 探讨临床淋巴结阴性(cN₀)甲状腺微小乳头状癌(PTMC)患者颈中央区淋巴结转移(CLNM)预测模型。方法 本研究纳入2015—2020年在西安交通大学第一附属医院耳鼻咽喉头颈外科手术确诊的cN₀-PTMC患者共1271例,根据手术记录和术后病理结果统计年龄、性别、肿瘤最大径、肿瘤位置、侧别、BRAF^V600E基因突变、伴结节性甲状腺肿(NG)和桥本氏甲状腺炎(HT)情况、腺外侵犯、被膜侵犯、颈淋巴结转移等临床病理资料,分析CLNM与各临床病理参数的相关性。结果 采用年龄45岁作为分类标准进行单因素分析。结果显示男性患者、年龄、肿瘤直径、是否伴HT、是否多灶性均与cN₀-PTMC发生CLNM相关(P＜0.05)。伴NG、BRAF^V600E基因突变、肿瘤位置、腺外侵犯、肿瘤侧、被膜侵犯均与cN₀-PTMC发生CLNM无相关性(P＞0.05)。继续进行非条件Logistic回归分析,结果显示男性患者(OR=1.929,95%CI: 1.465~2.541),年龄≤45岁(OR=2.581,95%CI:2.004~3.324),多灶性(OR=1.675,95%CI: 1.276~2.197)是cN₀-PTMC患者发生CLNM的独立危险因素;直径≤5 mm(OR=0.603,95%CI: 0.463~0.785)和伴HT(OR=0.642,95%CI: 0.452~0.913)是cN₀-PTMC患者发生CLNM的保护因素。伴HT是cN₀-PTMC患者BRAF^V600E基因野生型的危险因素(OR=3.454,95%CI: 1.865~6.397)。结论 男性患者、年龄≤45岁、肿瘤直径＞5 mm、不伴HT、多灶性是cN₀-PTMC患者发生CLNM的独立危险因素。伴HT是此类患者发生BRAF^V600E基因突变的保护因素,与其他临床病理特征无相关性。     

侧颈部淋巴结示踪技术在甲状腺癌手术治疗中的应用

目的 探究纳米炭示踪技术在甲状腺癌侧颈部淋巴结评估中的价值。 方法 研究为前瞻性、多中心队列研究,纳入体格检查阴性、影像学怀疑侧颈部淋巴结转移的甲状腺乳头状癌患者。术中用纳米炭示踪后进行侧颈部淋巴结清扫术。根据是否炭染,将侧颈部淋巴结分区送检,统计两组淋巴结的分区以及转移情况,并根据患者的临床病理特征进行亚组分析。以颈部淋巴结清扫的结果作为金标准,计算前哨淋巴结活检的敏感度及准确率。 结果 122例患者接受示踪手术,共计颈部淋巴结125例/侧。其中有侧颈部淋巴结转移117例,有中央区淋巴结转移7例,无颈部淋巴结转移1例。炭染淋巴结的中位数为6枚,其分布为Ⅳ区>Ⅲ区>Ⅱ区>Ⅴ区,分布规律与肿瘤大小、位置、腺外侵犯无关。炭染淋巴结的转移概率在各个淋巴结分区中均显著高于非炭染淋巴结(Ⅱ区:19.9%比5.6%,P<0.001;Ⅲ区:35.0%比18.3%,P<0.001;Ⅳ区:37.1%比15.2%,P<0.001;Ⅴ区:14.8%比3.7%,P<0.05)。侧颈部前哨淋巴结活检的敏感度为89.5%,准确率为91.8%。 结论 侧颈部淋巴结的炭染规律与甲状腺癌淋巴引流的规律基本一致,炭染淋巴结的转移概率显著高于非炭染淋巴结,是潜在侧颈部前哨淋巴结活检的示踪方法。     

甲状腺乳头状癌cN0患者中央区淋巴转移的研究

目的 探讨临床淋巴结阴性(cNO)甲状腺乳头状癌患者中央区(Ⅵ区)淋巴转移规律及清扫的临床价值.方法 回顾性分析中国医学科学院肿瘤医院头颈外科2003年1月至2006年12月初治的cNO甲状腺乳头状癌并行中央区淋巴清扫的108例患者临床资料.研究患者性别、年龄、肿瘤多中心病灶、被膜外侵、肿瘤大小、部位与中央区淋巴转移的关系.影响中央区淋巴转移率单因素差异比较采用 x2检验,Logistic模型进行多因素分析,Kaplan-Meier法计算生存率、颈侧复发率和远处转移率.结果 cNO甲状腺乳头状癌中央区淋巴转移率为59.2%(64/108),年龄小于45岁、甲状腺被膜受侵、肿瘤直径＞3 cm是中央区淋巴转移的独立危险因素(比值比分别为5.514、5.610和3.122,P值均＜0.05).本组中央区淋巴清扫喉返神经暂时性麻痹发生率为1.8%(2/108).术后暂时性低钙发生率为4.6%(5/108),永久性低钙发生率为0.9%(1/108).中位随访时间53个月,6例患者颈侧复发转移,2例局部复发,其中1例患者局部复发后死亡.5年颈侧复发率、生存率分别为4.8%、99.1%.结论 cNO甲状腺乳头状癌中央区淋巴转移率高,中央区淋巴清扫术后并发症的发生率低,建议对cNO甲状腺乳头状癌患者行中央区淋巴清扫.     

甲状腺乳头状癌cN0患者颈侧区淋巴结转移规律的探讨

目的 探讨甲状腺乳头状癌cNO患者颈侧区淋巴结转移状况及规律.方法 回顾性分析106例甲状腺乳头状癌cNO患者的临床及病理资料.所有患者均为首次手术,手术方式均为甲状腺全切除或近全切除+中央区淋巴清扫+颈侧区淋巴清扫.分析指标包括患者性别、年龄、原发灶大小、肿瘤是否多发、肿瘤T分级及中央区淋巴结转移状况,同时对肿瘤原发灶位置与颈侧区淋巴结转移区域的关系进行探讨.结果 cNO甲状腺乳头状癌颈侧区淋巴结转移与男性(P=0.007)、原发灶最大径＞1 cm(P =0.014)、肿瘤T分级为T3、T4 (P=0.006)及中央区淋巴结阳性数≥2枚(P＜0.001)有关,而与年龄(P =0.947)及肿瘤是否多发(P =0.710)无关.颈侧区淋巴转移以Ⅲ区(47/116,40.5％)、Ⅳ区(41/116,35.3％)最常见,其次是Ⅱ区(18/116,15.5％),而Ⅴ区转移少见(2/29,6.9％).其中89.8％(79/88)的Ⅲ、Ⅳ区淋巴转移发生于原发灶位于(或包含)甲状腺中下极的患者,77.8％ (14/18)的Ⅱ区淋巴转移发生于原发灶位于(或包含)甲状腺上极的患者,83.3％(15/18)的Ⅱ区转移同时伴随着Ⅲ区转移.2例Ⅴ区淋巴转移的患者都伴有Ⅱ、Ⅲ、Ⅳ区同时转移.结论 对于男性、肿瘤为T3、T4级及中央区淋巴结阳性数≥2枚的甲状腺乳头状癌患者建议术中常规清扫颈侧Ⅲ、Ⅳ区淋巴结,如肿瘤位于甲状腺上极或Ⅲ区淋巴结阳性者还应清扫Ⅱ区,只有当Ⅱ、Ⅲ、Ⅳ区同时有淋巴转移时才应考虑Ⅴ区淋巴清扫术.对于肿瘤最大径≤1 cm且局限于甲状腺内及无中央区淋巴转移的甲状腺乳头状癌患者不建议行预防性颈侧区淋巴清扫术.     

甲状腺乳头状癌前上纵隔淋巴结转移临床病理特征初步分析

目的 探讨肿瘤位置、最大直径及甲状腺外浸等临床病理特征与甲状腺癌前上纵隔淋巴结转移的关系。 方法 研究分析初次手术治疗的60例甲状腺乳头状癌患者临床及病理资料,运用检验临床病理特征与前上纵隔淋巴结阳性率的相关性。 结果 肿块位置、最大直径、数量、腺体外侵、受累腺叶数及Ⅵ区淋巴结转移等特征,以及患者年龄等相关因素中,只有VI区淋巴结对前上纵隔淋巴结状态有影响;60例患者前上纵隔淋巴结转移率为10/60(16.67%)。相关因素的前上纵隔淋巴结转移率对比:≥55岁vs <55岁(20% vs 16.36%, P<0.05);肿块位于下极 vs 上极 vs 中极(P>0.05);最大直径≥1.5 cm vs 最大直径<1.5 cm(18.18% vs 15.79, P>0.05);单灶 vs 多灶(21.88% vs 10.71%, P>0.05);单叶 vs 多叶(17.5% vs 15%, P>0.05);男性vs女性(20% vs 15.55%, P>0.05); Ⅵ区淋巴结阳性vs 阴性(24.43% vs 3.57%, P<0.05); 结论 总体来说,甲状腺乳头状癌前上纵隔淋巴结转移率较低。本研究发现VI区淋巴结状态可能与前上纵隔淋巴结转移相关,未来仍需大样本前瞻性的研究验证。     

Analysis of risk factors for lateral lymph node metastasis in papillary thyroid carcinoma: A retrospective cohort study

ObjectiveTo investigate the risk factors for lateral lymph node metastasis (LLNM) in papillary thyroid carcinoma (PTC).MethodsA retrospective analysis of 209 patients with PTC who underwent primary surgery at the Beijing Friendship Hospital affiliated with Capital Medical University from November 2014 to November 2018 was performed. The patients were divided into the LLNM group and the non‐LLNM group. The clinical and pathological characteristics of the patients were analysed. The risk factors for LLNM were analysed by univariate and multivariate analyses.ResultsThe incidence of LLNM was 13.4% in PTC patients. Univariate analysis showed that the maximum diameter of the primary tumour > 2 cm (P < 0.001), bilateral primary tumour (P = 0.020), extrathyroidal extension (ETE) (P < 0.001), central lymph node metastasis (CLNM) (P < 0.001), and CLNM number ≥ 5 (P < 0.001) were significantly associated with LLNM. Multivariate logistic regression analysis showed that the maximum diameter of the primary tumour > 2 cm, ETE, and CLNM were independent risk factors for LLNM (OR values were 3.880, 5.202, and 4.474, respectively). There were 6 patients with skip lateral cervical lymph node metastasis, accounting for 21% of all LLNM patients.ConclusionThis study revealed several independent risk factors for predicting LLNM in PTC patients, such as the maximum diameter of the primary tumour > 2 cm, ETE and CLNM. Lateral neck dissection may be recommended in PTC patients with those risk factors. Paying attention to the occurrence of skip lateral cervical lymph node metastasis during the clinical diagnosis and treatment processes is necessary.     

基于CT影像组学诺模图术前预测甲状腺乳头状癌颈部中央区淋巴结转移的研究

目的 探讨基于CT影像组学与临床危险因素的诺模图在术前预测甲状腺乳头状癌颈部中央区淋巴结转移中的价值.方法 回顾性分析114例PTC患者,收集治疗前的CT及临床资料.以7:3比例通过完全随机方法将入组患者分为训练集(n=85)和测试集(n=29),从CT平扫期和增强动脉期的图像中提取影像组学特征.在训练集中,使用方差阈...     

甲状腺乳头状癌钙化的临床意义

目的:探讨钙化在甲状腺乳头状癌中表达的意义.方法:回顾性分析甲状腺乳头状癌患者88例,探讨甲状腺乳头状癌内钙化灶与患者年龄、TSH水平、癌灶大小和肿瘤TNM分期有无相关性.结果:钙化与患者年龄、TNM分期和TSH水平没有明显相关性,而与肿瘤大小呈正相关,肿瘤直径越大,发生钙化的可能性越高(P<0.05).统计发现TSH水平与肿瘤大小也没有明显相关性.结论:钙化尤其是微钙化对提示甲状腺乳头状癌有一定的指导意义,而钙化的发生与肿瘤大小成正比,肿瘤越大,发生钙化的可能性越高.     

Lymph node ratio as a prognostic factor for survival in patients with head and neck squamous cell carcinoma

Objective

The purpose of this study is to validate the concept of lymph node ratio (LNR) in head and neck squamous cell carcinoma (HNSCC).