Level IIb lymph node metastasis in neck dissection for papillary thyroid carcinoma

OBJECTIVE: To determine the patterns of lateral cervical metastasis and the incidence of level IIb lymph node metastasis in papillary thyroid carcinoma. DESIGN: Retrospective medical record review. SETTING: Academic medicine. PATIENTS: From March 1, 2000, to April 30, 2006, 46 consecutive patients (38 women and 8 men) with papillary thyroid carcinoma. INTERVENTIONS: Patients underwent 55 modified radical neck dissections for the management of lateral cervical metastasis. MAIN OUTCOME MEASURES: All patients had preoperative evidence of a metastatic cervical lymph node. All specimens were labeled and mapped by the operating surgeon to identify their levels. RESULTS: Among 55 specimens, 82% (45 specimens) exhibited nodal disease at multiple levels. The incidences of metastases at level II, III, IV, and V nodes were 60% (33 specimens), 82% (45 specimens), 75% (41 specimens), and 20% (11 specimens), respectively. Skip metastases were present at a low rate (6% [3 specimens]). Among 12 specimens (22%) with metastatic lymph nodes at level IIb, 92% (11 specimens) had disease at level IIa. The rate of level IIb lymph node involvement in patients with metastatic lymph nodes at level IIa was 34% (11 of 32). CONCLUSIONS: Tumor involvement at multiple nodal levels usually occurs when patients have lateral cervical lymph node metastasis. Neck dissection should include the level IIb lymph node whenever level IIa lymph node metastasis is found. Level IIb dissection is probably unnecessary when level IIa lymph nodes are uninvolved because the incidence of metastasis to level IIb is low if level IIa is not involved.     

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。     

Level IIb lymph node metastasis in laryngeal squamous cell carcinoma

OBJECTIVES: Selective neck dissection, despite preservation of the spinal accessory nerve, can lead to some degree of postoperative shoulder dysfunction as a result of removal of level IIb lymph nodes. The aim of this study was to determine whether level IIb lymph nodes can be preserved in elective or therapeutic neck dissection as a treatment for patients with laryngeal squamous cell carcinoma (SCC). STUDY DESIGN: This was a prospective analysis of a case series. METHODS: A prospective analysis of 65 patients with laryngeal SCC who underwent surgical treatment of the primary lesion with simultaneous neck dissection from January 1999 to December 2002 was performed. During the neck dissection, the contents of the level IIb lymph nodes were dissected, labeled, and processed separately from the remainder of level II nodes and the main neck dissection specimen. The incidence of pathologic metastasis to level IIb lymph nodes and the regional recurrence within this area were evaluated. In addition, several potential risk factors for metastatic disease in the level IIb lymph nodes such as sex, age, cT stage, cN stage, and the presence of other positive lymph nodes were also evaluated. RESULTS: A total of 125 neck dissections were performed in this series. Of these dissections, 102 (82%) were elective and 23 (18%) were therapeutic. The prevalence of metastases in the level IIb lymph nodes was 1% (one of 46) and 0% (zero of 56) in clinically node-negative (N0) ipsilateral and contralateral necks, respectively, and 37% (seven of 19) and 0% (zero of four) in clinically node-positive ipsilateral and contralateral necks, respectively. There was a statistically significant association between level IIb metastases and clinically positive N stage (P<.001). The presence of other positive lymph nodes was also shown to have a statistically significant association with metastasis in the level IIb lymph nodes (P=.001). Only two of 46 patients (4%) with clinically N0 necks developed a regional recurrence. However, three of eight cases (38%) with positive pathologic level IIb lymph nodes developed regional recurrence. CONCLUSION: Level IIb lymph node pads may be preserved in elective neck dissection in patients with laryngeal SCC. However, this area should be removed thoroughly during therapeutic neck dissection in the treatment of clinically node-positive necks.     

甲状腺乳头状癌临床NO患者颈部淋巴结转移规律

目的 探讨甲状腺乳头状癌临床NO( clinical NO,cN0)患者颈部淋巴结转移规律和外科处理方式.方法 前瞻性研究2007年8月至2010年9月51例甲状腺乳头状癌cNO患者.术前采用核素法和染料法定位前哨淋巴结,并行术中冰冻病理检查,与术后颈清扫标本常规病理进行对照.记录51例患者53侧颈部淋巴结清扫转移淋巴结的数量及在Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ区的分布情况.研究患者年龄、肿瘤多中心病灶、被膜外侵、肿瘤大小、中央区淋巴转移数目与颈侧区淋巴转移的关系,影响颈侧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.结果 颈部淋巴结隐匿性转移率77.4％ (41/53),颈侧隐匿性转移率58.5％(31/53),中央区淋巴转移≥3枚是颈侧区淋巴转移的独立危险因素.pNO 12侧,pN+41侧,17侧仅有1个分区转移,占pN+的41.5％( 17/41);2个或2个以上分区转移24侧,占pN+的58.5％( 24/41).转移淋巴结分布以Ⅵ区最常见,为62.3％(33/53),其次为Ⅲ区52.8％(28/53),Ⅳ区30.2％(16/53),Ⅱ区18.9％(10/53),Ⅴ区0％ (0/53).结论 甲状腺乳头状癌cNO患者隐匿性淋巴结转移以多区转移为主,Ⅵ、Ⅲ、Ⅳ、Ⅱ区常见.中央区淋巴转移≥3枚较易出现颈侧淋巴转移,对cNO患者选择性清扫Ⅱ、Ⅲ、Ⅳ、Ⅵ区能清除大部分存在的颈部隐匿性转移淋巴结.     

甲状腺乳头状癌颈部淋巴结转移规律临床分析

目的探讨甲状腺乳头状癌（papillary thyroid carcinoma,PTC）颈部淋巴结转移规律及清扫范围的合理选择,提高患者生存质量。方法回顾性分析我院2007年10月～2009年9月收治的160例行功能性颈部淋巴结清扫术（functional node dissection,FND）患者,按VI区阳性淋巴结数由少到多分为4组：组1（对照组）,54例患者,淋巴结数0个;组2,52例患者,淋巴结数1～2个;组3,28例患者,淋巴结数3～4个;组4,26例患者,淋巴结数≥5个。应用χ2检验和Logistic回归方法分析比较各组淋巴结转移规律。结果性别、年龄、体重指数与II～IV区淋巴结转移无关（P均〉0.05）,原发灶侵及范围和VI区阳性淋巴结数均与II～IV区淋巴结转移有关（χ2=8.025,P〈0.05;χ2=17.234,P〈0.05）。诸因素与V区淋巴结转移的关系无关（P均〉0.05）。另随VI区阳性淋巴结数增加,II～IV区淋巴结转移相对危险度依次增加,肿物范围侵出腺叶时患者II～IV区淋巴结转移是腺内II～IV区淋巴结转移风险的2.48倍。结论 PTC原发灶侵及范围及VI区淋巴结转移情况对II～IV区淋巴结转移的影响有统计学意义,并随VI区阳性淋巴结数增加,II～IV区淋巴结转移相对危险度依次增加。淋巴结转移规律研究可为临床合理选择颈部淋巴结清扫范围、选择更适宜的术式提供依据,进一步提高患者生存质量。     

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.     

Predictive factors for lateral occult lymph node metastasis in papillary thyroid carcinoma

Management of lateral no necks in papillary thyroid carcinoma (PTC) is very controversial. The aim of this study was to find predictive factors of lateral neck involvement in N0 PTC to help the clinician in his decision to treat the lateral compartment. We retrospectively analysed 173 patients who underwent thyroidectomy and lateral prophylactic neck dissection for PTC >10 mm. Predictive factors for occult lateral lymph node metastasis including sex, age, tumour size, multifocality and bilaterality, tumour extracapsular spread, vascular invasion and presence of a tumour capsule were examined by multivariate analysis. There were three independent predictive factors for occult lateral lymph node metastases in multivariate analysis: tumour extracapsular spread (p < 0.0001), vascular invasion (p < 0.001) and age <45 years (p < 0.027). When none of these factors was present, the risk of occult metastases was <5 %. The risk increased up to 56 % when at least two of these factors were present. These findings suggest that, in patients older than 45 years with neither tumour extracapsular spread nor vascular invasion on histopathological examination, occult lymph node metastases are very uncommon. In that case further discussion regarding the risks and benefits of lateral nodal dissection may be warranted.     

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。     

甲状腺乳头状微小癌淋巴结转移相关因素分析

目的：探讨甲状腺乳头状微小癌颈部淋巴结转移的相关因素,以及一期手术时行择区性淋巴结清扫术的意义。方法：甲状腺乳头状微小癌患者82例中,术中冷冻病理诊断为甲状腺乳头状微小癌者60例（第1组）,行择区性颈淋巴结清扫术;术中冷冻病理诊断为甲状腺良性疾病者22例（第2组）,未行择区性淋巴结清扫术。结果：行择区性颈淋巴结清扫术60例中,13例（21.67%）出现颈部淋巴结转移;最大直径〈0.7cm与≥0.7cm的肿瘤转移率分别为4.76%和30.77%,差异有统计学意义（P〈0.05）。所有患者平均随访59.8个月,无复发和死亡,未发现远处转移。结论：甲状腺乳头状微小癌具有一定比例的颈部淋巴结转移率,尤其对于肿瘤最大直径≥0.7cm者行择区性淋巴结清扫术是更有效的治疗方法。     

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。     

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.     

分化型甲状腺癌Ⅵ区与Ⅱ-Ⅴ区淋巴转移的关系及预后

目的探讨分化型甲状腺癌Ⅵ区与颈侧区（Ⅱ-Ⅴ）区颈淋巴转移的特点，为临床选择正确术式提供依据。方法回顾性分析1984年3月至2000年12月，99例甲状腺癌患者在辽宁省肿瘤医院头颈外科进行初次手术，同期行颈清扫术，进行病理检查，术后随访，并对结果进行统计分析。结果99例分化型甲状腺癌中，乳头状甲状腺癌61例（双侧乳头状甲状腺癌1例），乳头滤泡混合型13例，滤泡状甲状腺癌25例。根据2002年UICCTNM分期：Ⅰ期60例，Ⅱ期1例，Ⅲ期5例，Ⅳ期33例。一侧腺叶及峡部切除80例，一侧腺叶及对侧大部或次全切除15例，全甲状腺切除术4例。全部患者同期颈清扫术104侧（双颈清扫5例），其中经典性清扫66例（68侧），改良性清扫33例（36侧）。术后病理检查淋巴结阳性83例（86侧），其中3例双侧淋巴结阳性，颈淋巴转移率为83．8％（83／99）。VI区阳性率37．5％（39／104），颈侧区（Ⅱ-Ⅴ区）阳性率76．9％（80／104），VI区和颈侧区淋巴结阳性率比较，差异有统计学意义（配对X^2检验，X^2=33．01，P〈0．01）。统计分析表明颈侧区淋巴转移和Ⅵ区淋巴转移无相关性（独立X。检验，X^2=2．08，Pearson列联系数C=0．14，P〉0．05）。10年、15年生存率分别为88．3％和84．5％。结论分化型甲状腺癌Ⅵ区与颈侧区（Ⅱ-Ⅴ区）淋巴转移率不同。不能仅从Ⅵ区转移判断颈侧区是否有转移。发生Ⅵ区淋巴转移的患者不比颈侧区（Ⅱ-Ⅴ区）淋巴转移的预后差，经过正确的外科治疗，预后较好。     

Intratumoral lymphatics and lymph node metastases in papillary thyroid carcinoma

OBJECTIVE: To examine the relationship between lymphatic vessel density and clinical and pathological variables in patients with well-differentiated papillary thyroid carcinoma. SUBJECTS: Clinical information was retrieved on 109 previously untreated patients with well-differentiated papillary thyroid carcinoma treated with total thyroidectomy and postoperative iodine I 131 ablation. Median follow-up was 38 months. DESIGN: Archived tissue specimens were sectioned and stained with hematoxylin-eosin and anti-LYVE-1 antibody, a highly specific marker for lymphatic endothelium. The size of the tumor and its multifocality were noted and lymphatic vessel density was measured by means of Chalkley point counting. RESULTS: Numerous intratumoral lymphatics were seen in papillary thyroid carcinoma. There was a highly significant association between the presence of intratumoral lymphatics and the presence of neck node metastases (P<.001). There was also a significant association with male sex (P =.03) and the presence of multifocal disease (P =.05). The presence of intratumoral lymphatics remained significantly associated with the presence of nodal metastases at presentation (P =.003) on multivariate analysis. Intratumoral lymphatics were not a significant predictor of tumor recurrence (P =.42, log-rank test). CONCLUSIONS: The development of intratumoral lymphatics in well-differentiated papillary thyroid carcinoma appears to be associated with the spread of tumor to regional lymph nodes. The antimetastatic potential of targeting these lymphatics may be of potential therapeutic benefit in the future.     

Diagnosis of lateral cervical lymph node metastasis of papillary carcinoma of the thyroid by ultrasonography

No consensus for papillary carcinoma of the thyroid exists on the preoperative diagnosis of lateral cervical lymph node metastasis, indications, or range of neck dissection, so we studied the usefulness and limits of ultrasonography and sufficient dissection by comparing preoperative ultrasonographic and postoperative histopathological diagnosis. Subjects were 45 patients (51 affected sides) with lateral cervical lymph node metastasis of papillary carcinoma of the thyroid who underwent modified neck dissection between July 1997 and July 2003. Preoperative ultrasonographic and postoperative histopathological diagnosis were compared. Specimens excised by neck dissection contained 1,325 lymph nodes. Of these, 198 (15%) detected by preoperative ultrasonography were selected for investigation of diagnostic criteria for metastasis-positive lymph nodes. The best criterion for the diagnosis of metastasis-positive lymph node was 0.5 or greater [minor axis/major axis] with 6 mm or greater minor axis at levels III, IV, or V (7 mm or greater at level II), and sensitivity, specificity, and accuracy were 78%, 100%, and 84% respectively. The lateral cervical lymph node metastasis rate obtained by this diagnostic criterion was 41%. Regional histopathological metastasis positivity was investigated in the lateral cervical region, and high positivity rates were obtained: 57% at level II, 71% at level III, and 84% at level IV. Considering these findings and the preoperative ultrasonographic diagnosis rate of 41%, sufficient dissection at levels II-IV may be necessary for patients in whom lateral cervical metastasis is observed before surgery. The metastasis rate was 10% at level V, but dissection should always be done in lateral cervical metastasis-positive patients because: 1) No trend was observed in age, gender, the number of metastatic lymph nodes, or regional metastasis rate; 2) no anatomical boundary is present between levels II, III, IV and level V; 3) no functional disorder due to preservation of the accessory nerve occurred; 4) the prognosis of patients with advancement to the accessory nerve was poor; and 5) improvement of the prognosis of papillary carcinoma of the thyroid by modified radical neck dissection has been reported.     

The presence of large lymph node metastasis as a prognostic factor of papillary thyroid carcinoma

OBJECTIVE: Papillary thyroid carcinomas often metastasize to regional lymph nodes, but the significance of lymph node metastasis as a prognostic factor has not been established. This study was conducted to determine the survival rate in patients with and without large lymph node metastasis greater than 3 cm in the maximum diameter, which are N2 or N3 for other head and neck cancers. METHODS: The survival rate was determined by using Kaplan-Meier method in 67 patients with previously untreated papillary thyroid carcinoma who underwent radical surgery at the Department of Otolaryngology, Toyooka Hospital, between 1993 and 2000. RESULTS: The prognosis was significantly poor (P=0.004) in patients with large lymph node metastasis greater than 3 cm in the maximum diameter. No significant difference was noted in the prevalence of large lymph node metastasis greater than 3 cm in the maximum diameter between different T groups. CONCLUSION: Large lymph node metastasis was considered to be a poor prognostic factor of papillary thyroid carcinoma independent of the T classification.     

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.     

分化型甲状腺癌的颈淋巴转移规律

目的探讨分化型甲状腺癌颈部淋巴转移的规律及临床阳性淋巴结（cN＋）的颈部治疗模式；评价术前彩超在诊断甲状腺癌颈转移中的作用。方法回顾性分析我院2003年7月-2005年7月诊治93例（113侧）cN＋分化型甲状腺癌患者的临床资料，分为术前颈部淋巴结触诊阳性患者（64侧）和术前颈部触诊阴性，彩超诊断为颈淋巴转移患者（49侧）两组。记录术后颈清扫标本中转移淋巴结的数量及在Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ区的分布。结果93例患者中双侧颈转移占21．5％（20／93），113侧颈清扫标本中92侧（81．4％）为多分区转移；转移淋巴结在颈部的分布以Ⅱ、Ⅲ、Ⅳ、Ⅵ区为主，分别为60．2％（68／113）、70．8％（80／113）、61．9％（70／113）、58．4％（66／113）；Ⅴ区较少分布22．1％（25／113），差异有统计学意义（χ^2=64．597，P〈0．001）。颈部触诊阳性患者颈清扫标本中转移淋巴结数量（10．1个），多于颈触诊阴性、彩超检查阳性患者（6．9个）；淋巴转移区域也多于后者（3．18区与2．61区）；术前彩超检查可以发现43．4％（49／113）的颈部触诊漏诊的颈部淋巴转移。结论分化型甲状腺癌的颈部淋巴转移为多分区分布，Ⅱ、Ⅲ、Ⅳ、Ⅵ区为主要的转移部位；彩超在甲状腺癌颈淋巴转移的诊断中具有重要的价值；对cN＋的分化型甲状腺癌患者，应进行包括Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ区的改良性颈清扫术。