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。     

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。     

家族性甲状腺乳头状癌的生物学特征及治疗

目的 分析家族性甲状腺乳头状癌的临床生物学行为,并探讨其治疗方法.方法 回顾性分析2010年1月至2011年8月天津医科大学附属肿瘤医院收治的家族性甲状腺乳头状癌共15个家系36例患者的临床资料,并将随机抽取的同期散发性甲状腺乳头状癌95例患者作为对照组.结果 15例(41.7％)家族性甲状腺乳头状癌患者年龄≥45岁;12例(33.3％)双侧腺叶发病,20例(55.6％)多灶病变;27例(75.0％)伴颈部淋巴结转移;17例(47.2％)伴甲状腺良性结节.95例对照组中60例患者(63.2％)年龄≥45岁;12例(12.6％)双侧腺叶发病,21例(22.1％)多灶病变;51例(53.7％)伴颈部淋巴结转移;26例(27.4％)伴甲状腺良性结节.家族性甲状腺乳头状癌患者行甲状腺全切除22例,患侧腺叶及峡部切除14例;3例行单侧或双侧侧颈清扫及中央区颈清扫术,7例行单侧或双侧后侧颈清扫及中央区颈清扫术,6例行一侧后侧颈清扫及中央区颈清扫术+对侧中央区颈清扫术,20例行单侧或双侧中央区颈清扫术.结论 家族性甲状腺乳头状癌较散发性甲状腺乳头状癌具有发病年龄小,多灶发病及双侧发病比例高,颈部淋巴结转移率高的生物学特征.术前应详细询问家族史并评估病情,建议选择较为积极的治疗方式.     

彩超结合CT分区评估甲状腺乳头状癌淋巴结转移的探讨＊

目的：探讨术前彩超结合增强CT分区评估甲状腺乳头状癌淋巴结转移的价值。方法：收集术前行颈部彩超同时行颈部、纵隔薄层增强CT检查的115例（141侧）甲状腺乳头状癌的临床资料,分为彩超组、CT组及彩超结合CT组分析比较三组在评估不同区域甲状腺乳头状癌淋巴结转移中的作用。结果：评估颈中央区淋巴结转移,彩超、CT及彩超结合CT三组的准确率分别是61．0％,48．9％,62．4％;评估颈侧区淋巴结转移,彩超、CT及彩超结合CT三组的准确率分别是87．9％,78．7％,85．8％。彩超在颈中央区（P〈0．05）及颈侧区（P〈0．05）评估淋巴结转移的准确率均高于CT。彩超结合CT检查在颈中央区的准确率高于CT（P〈0．05）,而在颈侧区的准确率与CT比较差异无统计学意义（P〉O．05）。无论在颈中央区（P〉0．05）或在颈侧区（P〉0．05）,彩超与两者联合检查的准确率比较无统计学差异。术前CT考虑6例纵隔转移及1例咽旁间隙转移,术后病理证实均为淋巴结转移。纵隔增强CT扫描发现5例患者肺部转移。结论：彩超结合CT或单一彩超评估颈中央区及颈侧区甲状腺乳头状癌淋巴结转移的准确性要高于CT。CT可以评估纵隔等彩超探及不到的区域淋巴结转移,同时对肺部转移进行评估。彩超结合增强CT应用于甲状腺乳头状癌淋巴结的评估,较单一检查更加精确、全面。     

甲状腺乳头状癌前上纵隔颈淋巴结清扫的治疗现状[综述]

甲状腺乳头状癌约占分化型甲状腺癌的90%以上。甲状腺乳头状癌容易较早出现区域性淋巴结转移。根据最新的美国癌症综合委员会（AJCC）第8版甲状腺癌分期系统,前上纵隔淋巴结（Ⅶ区）淋巴结转移也已从第7版的N1b更改为N1a（VI区或VII区淋巴结转移,单侧或双侧）,而甲状腺乳头状癌前上纵隔颈淋巴结是否归属于中央区淋巴结进行清扫一直存在着争议。本文将从颈淋巴结的解剖分区及术式选择、中央区淋巴结的定界（前上纵隔淋巴结是否归属于中央区淋巴结）以及前上纵隔淋巴结的清扫相关研究,对甲状腺乳头状癌前上纵隔颈淋巴结清扫的治疗现状做一综述,以便进一步指导临床工作。     

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。     

甲状腺微小乳头状癌颈部中央区淋巴结转移的相关危险因素分析[综述]

近年来甲状腺微小乳头状癌（papillary thyroid microcarcinoma,PTMC）的发病率呈明显上升趋势,目前主要治疗方式为手术治疗,但在行腺叶切除时是否需要同期行颈部中央区淋巴结清扫术仍有较多争议。本文主要叙述性别、年龄、多病灶、病灶大小、肿瘤位置、被膜侵犯、慢性淋巴细胞性甲状腺炎、淋巴结转移相关基因等与甲状腺微小乳头状癌颈部中央区淋巴结转移的关系,总结行颈中央区淋巴结清扫术需要考虑的相关危险因素。     

cN0甲状腺微小乳头状癌淋巴结转移高危因素及行预防性清扫临床分析

目的 探讨影响cN0甲状腺微小乳头状癌淋巴结转移高危因素及行预防性清扫的意义及可行性。方法 回顾性分析济南军区总医院2008年2月至2012年9月术前诊断为cN0甲状腺微小乳头状癌行甲状腺全切并双侧中央区淋巴结及患侧Ⅲ、Ⅴ区(+)Ⅱ区淋巴结清扫162例的临床资料,统计年龄、性别、肿物大小、有无侵及甲状腺被膜情况、原发灶数目、肿瘤单双侧、颈部淋巴结转移、手术并发症,探讨临床特征与颈部淋巴结转移关系。结果 162例患者中74例(45.7%)患者发生颈部淋巴结转移,71例中央区淋巴结转移阳性,转移率为43.8%,45例颈侧区(Ⅲ、Ⅴ区(+)Ⅱ区)淋巴结转移阳性,转移率为29.6%。年龄、肿瘤有无浸润包膜是PTMC颈部淋巴结转移的危险因素。术后并发喉返神经麻痹发生率为0.62%(1/162),系肿瘤侵犯喉返神经切断喉返神经所致,其中1例(0.62%)术后颈部切口出血,行手术止血,2例(1.23%)皮下淤血,保守治疗治愈。2例(1.23%)术后乳糜漏,均为左侧清扫患者,行持续负压吸引、左颈静脉角局部加压包扎治疗后治愈。 59例(36.4%)患者术后出现低钙血症,血甲状旁腺PTH低于参考值下限,治疗后恢复正常。无永久性甲状旁腺损伤并发症发生。结论 对cN0PTMC行甲状腺全切并双侧中央区淋巴结清扫,高危患者行患侧Ⅲ、Ⅴ区(+)Ⅱ区淋巴结清扫具有重要意义并安全可行。     

头颈外科学

预防性颈部II区淋巴结清扫术对淋巴结阳性甲状腺乳头状癌患者的影响目的：通过术前超声（PU）检查伴有临床颈部淋巴结转移（levelIII,IV和/或V）的甲状腺乳头状癌（PTC）患者,探讨其隐匿性levelII淋巴结转移与发生频率、类型及预测因素的联系。方法：回顾性分析52例伴有levelIII,     

355例甲状腺乳头状癌患者再次手术原因分析

目的分析甲状腺乳头状癌术后再次手术的原因,探讨初次手术规范化操作的意义。方法收集中国医学科院肿瘤医院头颈外科及北京大学深圳医院甲乳外科收治的355例甲状腺乳头状癌再次手术患者的临床资料,统计初次手术中甲状腺区及侧颈区术式,对比再次手术情况,分析导致再次手术原因。结果355例患者甲状腺或中央区再次手术者273例,其中初次手术甲状腺切除规范组140例,再次手术距离初次手术平均时间（60.6±54.9）个月;不规范组133例,再次手术距离初次手术平均时间（54.1±41.2）个月,两组再次手术时间有统计学差异(t=0.340,P=0.022);侧颈区再次手术者共99例,其中清扫规范组56例,再次手术距离初次手术平均时间（39.3±33.8）个月;颈部清扫不规范组43例,再次手术距离初次手术平均时间（26±24.1）个月, 两组再次手术时间有统计学差异(t=0.178,P=0.041)。结论 甲状腺乳头状癌患者再次手术的主要原因是甲状腺切除范围不够或侧颈区清扫范围不足。初次手术,单侧单发病灶应至少行患侧及峡部切除加患侧中央区淋巴结清扫术,其余均应行双侧甲状腺全切加患侧中央区淋巴结清扫术。有颈部转移的患者,初次手术应至少行II（IIa）、III、IV区侧颈部清扫。     

Clinical study on papillary thyroid carcinoma presenting with lymph node metastasi

Papillary thyroid carcinoma (PTC) may metastasize to cervical lymph nodes. It is, however, uncommon for a palpable neck node alone to lead to the diagnosis of this disease when it is not apparent at presentation. Standard treatment for such cases has not yet been established. We retrospectively analyzed clinical courses in 8 patients with thyroid papillary carcinoma presenting with palpable lymph node metastasis at Hokkaido University Hospital between 1990 and 2003. Three had high thyrogloblin in cervical cystic lesions, leading to the diagnosis of PTC with lymph node metastasis. In 4, PTC was diagnosed by pathological examination of cervical lymph nodes initially diagnosed as lateral cervical cysts. Preoperative examination did not indicate PTC within the gland in any case. All 8 were alive at the last visit after follow-up from 23 to 150 months (mean: 78 months). Total thyroidectomy was done on 4 and thyroid lobectomy on 3. Pathological examination of resected thyroid glands confirmed multifocal papillary carcinoma from 4 mm to 15 mm in diameter. Six underwent unilateral neck dissection and 1 chose bilateral dissection. The other patient received no additional surgery on either the thyroid or neck after the single enlarged lymph node initially diagnosed as a lateral cervical cyst was resected. Postoperative radioiodine treatment was done in 2 undergoing total thyroidectomy. Recurrence in the cervical area were observed in 1 whose neck dissection was insufficient. Based on these observations, we concluded that patients who undergo thyroid lobectomy and adequate neck dissection may enjoy longer survival than those treated with total thyroidectomy without sacrificing thyroid and parathyroid function. We therefore propose a prospective study on the effectiveness of thyroid lobectomy with neck dissection including positive nodes in patients with occult PTC presenting with lymph node metastasis.     

影像学评估结合纳米碳在甲状腺癌淋巴结处理中的作用

目的：探讨术前影像学评估结合术中应用纳米碳在甲状腺癌淋巴结处理中的作用。方法：收集81例初治的甲状腺癌患者的临床资料,分为实验组（42例）和对照组（39例）。根据术前彩超结合增强CT评估及病理检查结果,分别行中央区清扫及择区性Ⅲ、Ⅳ区清扫或侧颈区清扫。实验组在甲状腺注入纳米碳,分别计数3种清扫方式的淋巴结总数、转移数、黑染数及黑染转移数,对照组分别计数3种清扫方式的淋巴结总数、转移数;检查2组甲状腺及中央区清扫标本中有无甲状旁腺。结果：实验组中央区及Ⅲ、Ⅳ区和侧颈区清扫标本淋巴结黑染率分别为80.0%、54.9%及39.1%。在中央区清扫标本中,对照组、实验组平均每侧检出的淋巴结数为（3.03±2.07）枚、（4.72±2.97）枚,差异有统计学意义（P〈0.01）;在Ⅲ、Ⅳ区清扫标本中,对照组、实验组平均每侧检出的淋巴结数为（5.53±3.78）枚、（10.29±3.36）枚,差异有统计学意义（P〈0.01）;在侧颈区清扫标本中,对照组、实验组平均每侧检出的淋巴结数为（13.40±9.67）枚、（14.56±6.28）枚,差异无统计学意义（P〉0.05）。3种清扫方式平均每侧检出的转移淋巴结数实验组和对照组比较均差异无统计学意义（均P〉0.05）。实验组68侧甲状腺或中央区清扫标本中有3侧检出甲状旁腺,对照组60侧甲状腺或中央区清扫标本中有9侧检出甲状旁腺,2组比较差异有统计学意义（P〈0.05）。结论：纳米碳在中央区清扫及侧颈区cN0者行择区性Ⅲ、Ⅳ区清扫时可以较好地标记淋巴结,提高了淋巴结检出率;侧颈区cN＋者,纳米碳没有提高淋巴结的检出率。纳米碳在甲状腺腺叶切除及中央区清扫时可以有效区别和保护甲状旁腺。     

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。     

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.     

Individualized optimal surgical extent of the lateral neck in papillary thyroid cancer with lateral cervical metastasis

Despite an excellent prognosis, cervical lymph node (LN) metastases are common in patients with papillary thyroid cancer (PTC). The presence of metastasis is associated with an increased risk of locoregional recurrence, which significantly impairs quality of life and may decrease survival. Therefore, it has been an important determinant of the extent of lateral LN dissection in the initial treatment of PTC patients with lateral cervical metastasis. However, the optimal extent of therapeutic lateral neck dissection (ND) remains controversial. Optimizing the surgical extent of LN dissection is fundamental for balancing the surgical morbidity and oncological benefits of ND in PTC patients with lateral neck metastasis. We reviewed the currently available literature regarding the optimal extent of lateral LN dissection in PTC patients with lateral neck metastasis. Even in cases with suspicion of metastatic LN at the single lateral level or isolated metastatic lateral LN, the application of ND including all sublevels from IIa and IIb to Va and Vb may be overtreatment, due to the surgical morbidity. When there is no suspicion of LN metastasis at levels II and V, or when multilevel aggressive neck metastasis is not found, sublevel IIb and Va dissection may not be necessary in PTC patients with lateral neck metastasis. Thus consideration of the individualized optimal surgical extent of lateral ND is important when treating PTC patients with lateral cervical metastasis.     

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.     

Management of lateral cervical metastases in papillary thyroid cancer: patterns of lymph node distribution

In this article we discuss the management of lateral cervical lymph node metastases in papillary thyroid cancer (PTC). We conducted a retrospective analysis of cases of PTC at our tertiary academic medical center involving 32 patients who underwent 39 neck dissections for the management of lateral cervical metastases from 2000 to 2007. Of these patients, 18 underwent primary neck dissections at the time of thyroidectomy after fine-needle aspiration biopsy confirmed the PTC. Secondary neck dissections for delayed metastases were performed in 14 patients who had previously undergone thyroidectomy for confirmed PTC. All 32 patients had positive nodes in at least one level. Our results highlight the high incidence of multilevel cervical metastasis associated with PTC and suggest the importance of including level II-B (submuscular recess) when performing a neck dissection; the upper posterior triangle (level V-A) is less likely to harbor occult tumor. Lateral neck metastasis from PTC is common and predictable; locoregional control is improved with a formal, comprehensive neck dissection at the time of thyroidectomy.     

Incidence and clinical characteristics of prelaryngeal lymph node metastasis in papillary thyroid cancer

There is little data that determine the clinical characteristics of prelaryngeal lymph nodes (PLN) metastasis in patients with papillary thyroid cancer (PTC). The aims of this prospective study were to evaluate the incidence and the clinical characteristics of metastasis to the PLN for PTC patients who underwent total thyroidectomy and prophylactic central neck dissection. Sixty-seven patients who underwent total thyroidectomy and prophylactic bilateral central lymph node neck dissection for PTC were enrolled. Central neck compartment was further divided into prelaryngeal, ipsilateral/contralateral paratracheal, and pretracheal regions. Clinicopathologic factors including age, sex, tumor size and location, extrathyroidal extension, and central and lateral nodal metastasis were evaluated. Of the 67 patients who underwent PLN dissection, 13 (19.4 %) had evidence of PLN metastasis. Tumor size was significantly larger in patients with PLN involvement (2.28 versus 1.12 cm; p = 0.020). Additionally, primary tumors larger than 1 cm, extrathyroidal extension, and isthmus involvement were more prevalent in PLN-positive patients. Patients with positive PLNs were also more frequently found to have lateral lymph node metastasis (23.1 vs. 1.9 %; p = 0.021), pretracheal lymph node metastasis (76.9 vs. 27.8 %; p = 0.003), and bilateral central lymph node metastasis (38.5 vs. 11.1 %; p = 0.031) than PTC patients without PLN involvement. The incidence of PLN metastasis in PTC patients who underwent prophylactic central lymph node neck dissection was 19.4 %. PLN metastasis was associated with tumor size, extrathyroidal extension, isthmus involvement, and other compartment lymph node metastasis.     

cN0甲状腺乳头状癌患者颈淋巴结转移的高危因素分析

目的 探讨cN0甲状腺乳头状癌颈淋巴结转移的高危因素.方法 回顾性分析北京同仁医院2009~2015年537例cN0甲状腺乳头状癌的临床资料,统计患者性别、年龄、多发灶、合并桥本甲状腺炎、突破包膜和肿瘤直径.结果537例cN0甲状腺乳头状癌患者颈淋巴结转移率30.9%(166/537),其中单纯VI区转移率24.95%(134/537),VI区+颈侧转移率5.21%(28/537),单纯颈侧率0.74%(4/537).卡方检验和多因素logistic回归分析显示颈淋巴结转移与男性、年龄<45岁、突破包膜与肿瘤直径>1 cm有关(P<0.05).术后17例患者暂时声嘶,1例失访,1例随访1.5年未完全恢复正常.术后61例患者暂时低钙,2例失访,2例分别随访1.5和4年,仍需补钙.结论对cN0甲状腺乳头状癌患者进行危险度分层,男性、年龄<45岁、突破包膜、肿瘤直径>1 cm是颈淋巴结转移的高危因素,建议个体化治疗,行预防性中央区淋巴结清扫.