Contralateral cervical and mediastinal lymph node metastasis in medullary thyroid cancer: systemic disease?

BACKGROUND: The current American Joint Committee on Cancer/International Union Against Cancer classification designates cervical and mediastinal lymph nodes as regional lymph nodes. In a unilateral thyroid neoplasm, however, involvement of the contralateral cervical lymph node compartment or the mediastinal lymph node compartment, both of which have been designated "distant" lymph nodes, may serve as a surrogate parameter of distant metastases. METHODS: This institutional series consisted of 105 consecutive patients with medullary thyroid cancer who underwent systematic dissections of both distant lymph node compartments. RESULTS: Thirty-eight patients had no distant lymph node metastasis, 36 patients had involvement of only 1, and 31 patients of both distant lymph node compartments. Significant associations (P < .001) were seen on univariate analysis between the number of involved "distant" lymph node compartments (none, one, or both) and extrathyroidal extension (3%, 33%, and 58%), the number of positive lymph nodes (means of 3, 13, and 33), and distant metastasis (8%, 36%, and 61%). In a multivariate logistic regression model, only involvement of one or both "distant" lymph node compartments (versus no distant lymph node metastasis) remained significantly related to distant metastasis in a dose-dependent fashion. CONCLUSIONS: "Distant" lymph nodes in medullary thyroid cancer should be regarded as nonregional lymph nodes because their involvement is indicative of distant metastasis.     

Skip metastases in medullary thyroid carcinoma: A single-center experience

PURPOSE: Total thyroidectomy (TT) with level VI and VII central neck dissection is the initial treatment for medullary thyroid carcinoma (MTC) without identifiable neck metastasis. Level II to V lateral neck dissection is performed if neck metastasis is present or suspected. We conducted this study to identify the frequency and clinical determinants of skip neck metastasis in MTC. METHODS: We reviewed the medical records of 32 patients who underwent TT and bilateral neck dissection for MTC. The clinical features were correlated with pN status in the central versus lateral compartments of the neck. RESULTS: Neck lymph node metastasis (pN+) was found in 20 patients (62.5%) and skip metastases were found in 7 (35%) patients. The sensitivity of the pN status of the central compartment of the neck to predict the pN status of the lateral compartment of the neck was 53.8% and specificity was 63.2%. We found pN+ in 90% of the patients with lymph nodes >15 mm in diameter versus 50% in those with lymph nodes <15 mm in diameter. CONCLUSIONS: There is skip metastasis in MTC. It is unsafe to use the lymph node status of the central compartment of the neck to define the pN status of the lateral neck. A lymph node greater than 15 mm in diameter is related to pN status.     

Pattern of Nodal Metastasis for Primary and Reoperative Thyroid Cancer

This retrospective investigation was undertaken to clarify the pattern of nodal metastasis in papillary (PTC) and medullary (MTC) thyroid carcinoma. Nodal metastases are associated with recurrence of both PTCs and MTCs. The extent of lymph node dissection is controversial owing to the lack of reliable diagnostic criteria for nodal metastases other than histopathology. Between November 1994 and October 1999 a total of 296 patients (134 PTCs, 162 MTCs) underwent total thyroidectomy in conjunction with a standard resection of at least the cervicocentral lymph node compartment. Of 10,446 sampled lymph nodes, 1641 were positive. All nodes were related to their respective cervicomediastinal compartments. The ipsilateral cervicolateral compartment was involved almost as often as the cervicocentral compartment in primary PTC (29% vs. 32%), reoperative PTC (21% vs. 37%), primary MTC (34% vs. 34%), and reoperative MTC (49% vs. 65%). The contralateral cervicolateral and mediastinal compartments were more rarely affected, and were least affected in the primary setting. From these data was derived an individualized surgical strategy for PTC and MTC. This concept rests on the joint resection of cervicocentral and ipsilateral cervicolateral compartments. Depending on tumor entity, surgical status, and primary tumor diameter, additional compartments may have to be cleared.     

甲状腺乳头状癌颈侧区淋巴结跳跃性转移危险因素分析

目的 探讨甲状腺乳头状癌（PTC）病人颈侧区淋巴结跳跃性转移的规律（中央区淋巴结无转移而颈侧区淋巴结有转移）及其主要危险因素。方法 回顾性分析2017年1月至2019年10月就诊于郑州大学第一附属医院甲状腺外科行手术治疗并经术后病理学检查证实有侧区淋巴结转移的275例PTC病人的临床资料,分析跳跃性转移的危险因素。结果 颈侧区淋巴结跳跃性转移的发生率为13.1%（36/275）,肿瘤位于上极（OR 2.780,95%CI 1.270～6.083;P=0.011）,年龄（OR 1.077,95%CI 1.039～1.116;P<0.001）,单侧癌（OR 2.459,95%CI 1.094~5.529;P<0.001）是PTC病人出现跳跃性转移的独立危险因素。ROC曲线显示,预测跳跃性转移的最佳年龄界值为48.5岁（敏感度=0.556,特异度=0.753,曲线下面积=0.680,P=0.001）。跳跃性转移病人检出的中央区淋巴结个数及颈侧区淋巴结转移个数与非跳跃性转移病人相比均较少。结论 PTC病人颈侧区淋巴结跳跃性转移并不少见,对肿瘤位于腺体上极,年龄≥48.5岁,单侧癌的病人应仔细评估,必要时可行颈侧区淋巴结清扫术。     

Lateral Cervical Lymph Node Metastases from Papillary Thyroid Carcinoma: Pattern of Nodal Metastases and Optimal Strategy for Neck Dissection

Background The pattern of lateral cervical metastases from papillary thyroid carcinoma (PTC) has been reported without a clear understanding of the distribution of central nodes at risk. The present study evaluated the pattern of central and lateral cervical metastases from PTC with respect to recently defined neck sublevels and subsites. Methods Between 2003 and 2006, 52 consecutive patients with lateral cervical metastases from previously untreated PTC underwent total thyroidectomy and therapeutic comprehensive neck dissection of the central and lateral compartments, including five bilateral neck dissections. Neck dissection specimens were separately obtained for analyzing lymph node involvement with respect to neck sublevels and subsites. Results For the lateral compartment, 75.9% of cases showed metastatic disease at level IV, 72.2% at IIa and III, 16.7% at IIb, 13.0% at Vai, 3.7% at Ib and Vb, and 0% at Vas. For the central compartment, 84.6% of cases showed metastatic disease at the ipsilateral paratracheal nodal site, 46.2% at the superior mediastinal, 30.8% at the pretracheal, and 8.9% at the contralateral paratracheal site. Forty-six of 57 lateral neck dissection samples (80.7%) showed multilevel disease, and skip lateral metastasis was found in five patients (9.6%). Level I and V involvements were always associated with multilevel disease. Conclusions Lateral cervical metastasis from PTC is commonly associated with multilevel disease and central nodal involvement. Neck dissection including ipsilateral central and lateral compartments may be the optimal treatment for these patients.     

Is central neck dissection necessary for the treatment of lateral cervical nodal recurrence of papillary thyroid carcinoma?

BACKGROUND: Although the pattern of cervical lymph node metastases from papillary thyroid carcinoma (PTC) has been described, little is known about the pattern of lateral cervical nodal recurrence. The aim of this study was to establish the optimal strategy for neck dissection in patients who underwent reoperation for lateral cervical recurrence of PTC. METHODS: We reviewed the records of 22 patients who underwent neck dissection for lateral nodal recurrence of thyroid cancer between 2002 and 2004. Eight patients had thyroid remnants or recurrent tumors in the bed and 6 had undergone lateral neck dissection prior to referral. Patients underwent comprehensive dissection of the posterolateral and ipsilateral (n = 10) or bilateral (n = 12) central neck. The pattern of nodal recurrence and postoperative morbidity were analyzed. RESULTS: All patients had lateral compartment involvement, 91% at mid-lower, 45% at upper, and 18% at posterior sites. Central nodes were involved in 86% of patients: 82% at ipsilateral paratracheal, 32% at pretracheal, 27% at superior mediastinal, and 2 patients at contralateral sites. Skip lateral recurrence with no positive central nodes was rarely observed (14%). Postoperative vocal cord palsy (n = 1) and hypoparathyroidism (n = 5) developed only in patients undergoing bilateral central compartment dissection. CONCLUSIONS: The inclusion of comprehensive ipsilateral central and lateral neck dissection in the reoperation for patients with lateral neck recurrence of PTC is an optimal surgical strategy.     

甲状腺乳头状癌颈侧区淋巴结跳跃性转移危险因素分析

目的 探讨甲状腺乳头状癌（PTC）病人颈侧区淋巴结跳跃性转移的规律（中央区淋巴结无转移而颈侧区淋巴结有转移）及其主要危险因素。方法 回顾性分析2017年1月至2019年10月就诊于郑州大学第一附属医院甲状腺外科行手术治疗并经术后病理学检查证实有侧区淋巴结转移的275例PTC病人的临床资料,分析跳跃性转移的危险因素。结果 颈侧区淋巴结跳跃性转移的发生率为13.1%（36/275）,肿瘤位于上极（OR 2.780,95%CI 1.270～6.083;P=0.011）,年龄（OR 1.077,95%CI 1.039～1.116;P<0.001）,单侧癌（OR 2.459,95%CI 1.094~5.529;P<0.001）是PTC病人出现跳跃性转移的独立危险因素。ROC曲线显示,预测跳跃性转移的最佳年龄界值为48.5岁（敏感度=0.556,特异度=0.753,曲线下面积=0.680,P=0.001）。跳跃性转移病人检出的中央区淋巴结个数及颈侧区淋巴结转移个数与非跳跃性转移病人相比均较少。结论 PTC病人颈侧区淋巴结跳跃性转移并不少见,对肿瘤位于腺体上极,年龄≥48.5岁,单侧癌的病人应仔细评估,必要时可行颈侧区淋巴结清扫术。     

The Delphian lymph node in thyroid cancer

OBJECTIVE: To determine the significance of Delphian lymph node (DLN) involvement in thyroid cancer. SUMMARY BACKGROUND DATA: The DLN has long been regarded as a predictor of thyroid malignancy and indicator of advanced disease; however, there are no published data in relation to the thyroid. METHODS: A retrospective cohort study with data obtained from the University of Sydney Endocrine Surgery database and histopathology records. The study cohort comprised 1000 consecutive patients undergoing total thyroidectomy. RESULTS: The DLN was separately removed and identified as such in 263 of 1000 (26.3%) patients. Of 1000 patients 203 (20.3%) had a diagnosis of papillary/medullary cancer. Of this group 150 patients had surgery performed for suspected cancer, and in 53 the diagnosis of cancer was unsuspected. In only 1 case did the DLN operative appearance alert the surgeon to an otherwise unsuspected thyroid cancer. The DLN was separately identified in 103 patients with cancer and, in this group, 22 of 103 (21.4%) had DLN metastases. DLN involvement was associated with greater nodal disease (9.8 vs. 1.6 nodes; P < 0.001), larger tumor size (19.4 vs. 11.1 mm; P < 0.003) and younger age (41 vs. 47 years; P = 0.058). DLN involvement was highly predictive of further disease in the central compartment (sensitivity = 41%, specificity = 95%), moderately predictive of further disease in the lateral compartment (sensitivity = 50%, specificity = 88%), and strongly suggestive of further nodal disease in the neck (sensitivity = 64%, specificity = 100%). CONCLUSIONS: Although the clinical appearance of the DLN is not an accurate indicator of the presence of unsuspected thyroid cancer, metastatic involvement of the DLN is an adverse prognostic marker in papillary/medullary thyroid cancer. The presence of DLN metastasis in patients with thyroid cancer should alert the surgeon to the high probability of advanced disease and need for greater attention to the central and lateral lymph node compartments.     

甲状腺乳头状癌跳跃性侧颈区淋巴结转移的危险因素分析

目的探究甲状腺乳头状癌（PTC）颈部淋巴结跳跃性转移的临床病理特征及其危险因素。 方法回顾性分析2015年7月至2018年11月福建医科大学附属协和医院收治的259例PTC患者临床资料,探究跳跃性侧颈区淋巴结转移的危险因素。 结果PTC颈部淋巴结跳跃性转移的发生率为9.3%（24/259）。单因素分析显示,中央区淋巴结清扫数目在跳跃性转移组中更少（P=0.031）;肿瘤最大径<1 cm（P<0.001）及肿瘤位于腺体上部（P=0.012）与PTC患者跳跃性转移的发生有关。多因素分析显示,肿瘤最大径<1 cm（OR=5.934,P<0.001）和肿瘤位于腺体上部（OR=2.812,P=0.023）是PTC患者颈部淋巴结跳跃性转移的独立危险因素。 结论肿瘤最大径<1 cm和肿瘤位于腺体上部的PTC患者侧颈区淋巴结更易发生跳跃性转移。     

Lateral and Mediastinal Lymph Node Dissection in Differentiated Thyroid Carcinoma: Indications,Benefits, and Risks

Background There are 3 compartments of regional lymph nodes to which thyroid carcinoma metastasizes: central, lateral, and mediastinal compartments. The central compartment is the nearest to the thyroid and usually dissected routinely. However, the indication for dissection of the lateral and mediastinal compartments for differentiated thyroid carcinoma remains an open question. Methods The indication for dissection of lateral and mediastinal compartments is evaluated based on previous reports, including those from our department. Results There is nothing controversial about the indication for therapeutic lateral node dissection for tumors with clinically apparent lateral node metastasis. Such cases are more likely to show recurrence, especially in previously dissected compartments, and surgeons must perform dissection carefully. Although there are no randomized studies on the indication for prophylactic lateral node dissection, it is recommended for papillary carcinoma with aggressive characteristics such as large size and massive extrathyroid extension. Prophylactic mediastinal dissection via median sternotomy is not recommended. Conclusions Node dissection of the lateral and mediastinal compartments must be performed aggressively and radically to prevent recurrence in previously dissected regions.     

未发现淋巴结转移的甲状腺乳头状癌中央区淋巴结清扫的临床病理分析

目的探讨颈部中央区淋巴结清扫在临床上未发现淋巴结转移（cN0）甲状腺乳头状癌患者中应用的意义。方法收集1998年1月至2006年4月收治的641例cN0甲状腺乳头状癌患者的临床病理资料,统计分析中央区淋巴结的转移情况,并分析其与患者的性别、年龄、原发灶大小及数目的关系。同时对治疗5年以上的114例患者进行随访,分析颈侧区淋巴结转移和对侧甲状腺腺叶复发与初治时中央区淋巴结病理隋况的关系。结果cN0甲状腺乳头状癌患者颈部中央区淋巴结转移的阳性率为53．0％。中央区淋巴结转移与原发灶的T分期和数目有关,与患者的性别和年龄无关。随访的114例患者中12例发生同侧颈侧区淋巴结转移,其中11例患者第一次手术时中央区淋巴结的转移阳性率较高。5例对侧甲状腺腺叶再发乳头状癌,其初治时中央区淋巴结病理情况差异较大。结论cN0甲状腺乳头状癌患者应常规行中央区淋巴结清扫;中央区淋巴结病理情况与肿瘤原发灶的数目有关;中央区淋巴结转移阳性率高者易出现同侧颈侧区淋巴结转移。     

Central Cervical Nodal Metastasis from Papillary Thyroid Microcarcinoma: Pattern and Factors Predictive of Nodal Metastasis

Background  Although several factors are thought to predict the occurrence of lymph node metastases from papillary thyroid microcarcinoma (PTMC), the pattern of nodal metastasis has been rarely studied. We evaluated the pattern and factors predictive of central cervical metastasis from PTMC. Methods  Seventy-two patients with PTMC underwent total thyroidectomy and central neck dissection, including three who underwent therapeutic modified radical neck dissection. Lymph node involvement was analyzed by neck subsite, and clinicopathologic variables predictive of nodal metastasis were determined. Results  Central and lateral nodal metastases were found in 29 (40.3%) and 3 (4.2%) patients, respectively, and ipsilateral paratracheal, pretracheal, superior mediastinal, and contralateral paratracheal lymph node metastases in 27 (37.5%), 8 (11.1%), 4 (5.6%), and 1 (1.4%), respectively. Sex, age, tumor size, multifocality, bilaterality, extracapsular invasion, lymphovascular invasion, and MACIS (metastases, age, completeness of resection, invasion, size) for central node metastasis were not predictive of metastasis (P > .1). Temporary and permanent hypocalcemia was observed in 17 (23.6%) and 1 (1.4%) patients, respectively, and transient vocal fold paralysis in 1 (1.4%). Conclusion  Despite the absence of palpable neck nodes, PTMC is associated with a high rate of central lymph node metastasis to ipsilateral and pretracheal subsites. No clinicopathologic factor predicted nodal metastasis. In patients with PTMC involving one lobe and positive nodes, neck dissection may exclude the contralateral side.     

Lateral Lymph Node Dissection Guided by Preoperative and Intraoperative Findings in Differentiated Thyroid Carcinoma

Background The lateral compartment frequently demonstrates metastasis from thyroid carcinoma. In contrast to that for central lymph node dissection, the indication for lateral node dissection remains controversial. Methods In this review we evaluate the indication of lateral lymph node dissection in papillary and follicular carcinomas based on the findings of previous reports, including those from our institute. Results Lymph node metastasis and recurrence at the lymph node are common events in papillary carcinoma. In particular, the lymph node recurrence rate in patients with clinically apparent lateral node metastasis (N1b) is high, not only in compartments that have not been dissected but also in those previously dissected, even if therapeutic lateral node dissection is performed. For N0 or N1a papillary carcinomas, male gender, being 55 or more years of age, a tumor larger than 3 cm, and massive extrathyroid extension are independent risk factors of lymph node recurrence, and patients with tumors having two or more of these clinicopathologic features showed high lymph node recurrence rates even if they underwent prophylactic lateral node dissection. In follicular carcinoma, node metastasis and recurrence at the node are rare events but they occasionally can be observed, especially in tumors with massive extrathyroid extension and poor differentiation. Conclusion N1b is an absolute indication for lateral lymph node dissection. Prophylactic lateral node dissection is also recommended in N0 or N1a papillary carcinoma, if the lesion shows two or more of the aggressive characteristics indicated above. For follicular carcinoma, prophylactic node dissection is not mandatory but can be an option for tumors demonstrating aggressive characteristics or histologic types.     

Lobe-specific skip nodal metastasis in non-small cell lung cancer patients.

PURPOSE: The purpose of this study is to clarify the lobe-specific nodal metastasis and optimal range of mediastinal nodal dissection in lung cancer patients with skip metastasis. MATERIALS AND METHODS: A total of 136 patients with pN2/3 disease were treated between 1988 and 2002, and these patients were divided into two groups according to whether skip metastasis was identified or not. We drew a comparison of the lobe specificity of mediastinal nodal involvement between skip positive and negative groups. RESULTS: Skip metastasis was identified in 48 (35.3%) of 136 pN2/3 patients. The lymph nodal regions most frequently found (target nodes) were as follows: right upper-#3 and right #4, middle & lower-#3, right #4 and #7, left upper-left #4, #5, and #6, and left lower-#7, #8, and #9. Skip metastasis can be detected at a rate of 82.6% to 91.7% by means of a histological examination of these target nodes. However, the frequency of skip metastasis in other mediastinal nodal regions excluding the target nodes was found to progress to a level of 33.3% to 57.1% insofar as tumor metastasis to these target nodes was identified. CONCLUSIONS: The examination of lobe-specific nodal regions may be helpful for determining patients with skip metastasis. If metastasis is found somewhere in these target nodes, then a systematic nodal dissection may be acceptable for a complete resection even if N1 metastasis is not identified.     

Systemic mediastinal lymph node dissection of right lung cancer: surgical quality control and analysis of mediastinal lymph node metastatic patterns

Standardization of systemic mediastinal lymph node dissection (SMLD) of lung cancer requires further investigation. A consecutive 124 right lung cancer patients were recruited for pulmonary resection plus SMLD. Three mediastinal lymph node compartments, (i) the upper compartment (station 1-4), (ii) the middle compartment (station 7-8) and (iii) the lower compartment (station 9), were en bloc collected to achieve surgical quality control and to analyze mediastinal lymph node metastatic patterns. The number of total harvested lymph nodes, N1 nodes and N2 nodes were 21.9+/-8.7, 9.2+/-4.7 and 12.8+/-6.7, respectively. Tumor location (peripheral or central) (P=0.023) and status of blood vessel invasion (P=0.002) were identified as risk factors for nodal involvement. Right upper lobe (RUL) cancer with N2 disease primarily metastasized to the upper compartment (27.3%) (P=0.001). For right lower lobe (RLL) cancer, lymph node metastasis most commonly detected in the middle compartment (48.8%) (P=0.001). Single mediastinal compartment metastasis occurred in 64.7% (11/17) of adenocarcinomas from RUL and RML, whereas multiple compartments metastasis occurred in all adenocarcinoma cases (12/12) from RLL (P=0.001). SMLD needs to standardize the extent of lymphadenectomy and number of removed lymph nodes for surgical quality control. Simplifying mediastinal lymph node stations to three compartments may benefit surgical excision.     

The pattern of mediastinal nodal involvement in lung cancer according to tumor-located lobe]

To clarify the pathway of the metastases from each pulmonary lobe to mediastinal nodes, we examined the pattern of mediastinal nodal involvement in 462 resected pN2 non-small cell lung cancer. Carcinomas of the right upper lobe frequently involved #3 (78/133) and #4 (70/133) nodes, whereas those of the right middle or lower lobe frequently metastasized to #7 nodes (18/23 and 86/113, respectively). On the other hand, carcinoma of left upper lobe frequently involved #5 nodes (81/118), whereas those of the left lower lobe most frequently metastasized to #7 nodes (50/75). Of 462 pN2 patients, 95 (20.6%) had skip metastases to the mediastinal nodes. Skip metastasis was observed more frequently in carcinomas of right upper and middle lobe. One of the reasons of skip metastasis may be the direct lymph drainage through subpleural space to mediastinum.     

Skip Lateral Neck Node Metastases in Papillary Thyroid Carcinoma

Background  

Papillary thyroid carcinomas (PTCs) are commonly associated with lymph node metastases (LNMs), which are thought to disseminate sequentially, first to the central compartment and later to the lateral compartment. However, a small number of patients have skip metastases to the lateral compartment without central LNMs. This study was performed to evaluate the clinicopathologic characteristics of skip metastases in PTC.     

Prediction of mediastinal lymph node metastasis in medullary thyroid carcinoma

BACKGROUND: Mediastinal lymph node metastases can be life threatening owing to their proximity to vital organs. Reliable identification of mediastinal metastasis is of utmost importance for timely mediastinal lymph node dissection, although suitable clinicopathological variables for their detection in patients with thyroid cancer have yet to be identified. METHODS: This was an analysis of 83 consecutive patients with radiological suspicion of mediastinal metastasis who underwent trans-sternal mediastinal lymph node dissection for node-positive medullary thyroid carcinoma between November 1994 and March 2003. RESULTS: Univariate analysis revealed that extrathyroidal extension (P < 0.001), distant metastasis (P = 0.001), the preoperative serum calcitonin level (P = 0.001), operation type (P = 0.004), contralateral cervicolateral metastasis (P = 0.016) and bilateral nodal metastasis (P = 0.031) were significantly associated with mediastinal involvement. Only extrathyroidal extension remained significant in a multivariate logistic regression analysis of mediastinal lymph node metastasis. Prediction of mediastinal metastasis by extrathyroidal extension was best at reoperation, with a specificity of 97 per cent and a positive predictive value of 88 per cent. CONCLUSION: Mediastinal lymph node dissection should be considered in patients undergoing reoperation for node-positive medullary thyroid carcinoma who have extrathyroidal extension and cervical lymph node metastases.     

甲状腺微小乳头状癌颈部淋巴结转移的危险因素分析

目的:探讨甲状腺微小乳头状癌(PTMC)颈部淋巴结转移的危险因素。方法:回顾性分析贵州医科大学附属医院甲状腺外科2014年1月—2016年3月收治的169例PTMC患者临床病理资料。结果:169例患者均行预防性中央区淋巴结清扫,其中54例(32.0%)发生中央区淋巴结转移,单因素分析发现中央区淋巴结转移与年龄45岁、多灶性肿瘤、侵出包膜有关(均P0.05),多因素分析显示,年龄、多灶性肿瘤、侵出包膜都是中央区淋巴结转移的独立危险因素(均P0.05)。30例行中央区淋巴结加侧颈区淋巴结清扫,其中18例(10.7%)发生侧颈区淋巴结转移,单因素分析显示,肿瘤最大径、侵出包膜、多灶性肿瘤、中央区淋巴结转移与侧颈区淋巴结转移有关(均P0.05),多因素分析显示,肿瘤侵出包膜为侧颈区淋巴结转移的高危因素(P0.05);11例(6.5%)发生中央区并侧颈区淋巴结转移,侵出包膜、多灶性肿瘤为中央区并侧颈区淋巴结共同发生转移的高危因素(均P0.05)。高分辨率颈部淋巴结B超对中央区淋巴结转移的灵敏度、特异度分别为14.8%、96.5%,其对侧颈区淋巴结转移的灵敏度、特异度分别为94.4%、83.3%。结论:年龄45岁、多灶性肿瘤、侵出包膜是PTMC颈部淋巴结转移的危险因素。高分辨率颈部淋巴结B超可以作为甲状腺癌颈部淋巴结转移术前评估的重要手段。     

胃癌哨兵淋巴结位置分布及其转移相关因素

目的　探讨胃癌哨兵淋巴结位置分布规律以及导致其转移的相关因素。方法　调查2 7例单个转移淋巴结、80例单组转移淋巴结的位置分布 ,比较单个转移淋巴结和 111例无转移淋巴结病人的临床病理参数。结果　 2 7个单个转移淋巴结中有 2 5个位于第 1站 ,跳跃转移 2个 ;2 1例胃下区、胃中区癌哨兵淋巴结中 16个在第 3、4组 ,6例胃上区癌哨兵淋巴结中 3个位于第 1组。pT3 期胃癌哨兵淋巴结转移的危险性高于pT1胃癌 ,比数比 (OR)为 4 92 6 (P <0 0 1) ,胃上区癌比胃下区癌哨兵淋巴结更易发生转移 (OR =4 381,P <0 0 5 ) ,早期胃癌哨兵淋巴结的转移危险性低于BorrmannⅠ型胃癌 (OR =0 0 82 ,P <0 0 5 )。结论　胃癌哨兵淋巴结多位于肿瘤附近 ,跳跃转移少见 ;肿瘤侵犯深度以及所在部位与哨兵淋巴结发生转移有关 ,利用胃癌哨兵淋巴结可以指导胃癌淋巴结切除范围的选择