术中选择性淋巴结冷冻病理检查对甲状腺乳头状癌中央区淋巴结状态的预测作用

Predictive value of lymph node status in central region by intraoperative selective frozen lymph node biopsy in papillary thyroid carcinoma

目的:探讨甲状腺乳头状癌(PTC)中央区淋巴结细化分区术中冷冻病理结果对淋巴结转移的提示作用,从而指导手术治疗方式。方法:选择2016年1月—2018年12月术后病理明确诊断PTC并有中央区淋巴结转移的患者298例为研究对象,回顾性分析术中喉前淋巴结、气管前淋巴结、气管旁淋巴结冷冻病理结果与术后石蜡病理结果的一致性,以及术中送检淋巴结数量与术后病理结果一致性的关系。结果:所有PTC患者均合并中央区淋巴结转移。术中冷冻送检淋巴结与术后石蜡病理结果一致性达到81.2%,假阴性率为15.4%。当送检淋巴结数量>5个时,术中冷冻病理结果与术后病理结果的一致性可达到93.7%,假阴性率为6.3%。结论:PTC颈部中央区淋巴结转移较为常见。术中选择喉前淋巴结、气管前淋巴结、气管旁淋巴结进行冷冻病理检查,可有效提示中央区淋巴结是否受累,且送检淋巴结数量>5个时可更加有助于判断中央区淋巴结是否转移。结合淋巴结转移的危险因素可为患者设计更为精准的手术方案。

Objective:To investigate the role of frozen pathological results in lymph node metastasis of papillary thyroid carcinoma(PTC),in order to guiding the surgical treatment.Methods:In this retrospective study,298 patients with definite postoperative pathological diagnosis of PTC from January 2016 to December 2018 were selected.And the consistency of intraoperative frozen pathological results of anterior laryngeal lymph nodes,anterior tracheal lymph nodes and paratracheal lymph nodes with postoperative pathological results was analyzed retrospectively,as well as the relationship between the number of lymph nodes and the consistency of postoperative pathological results.Results:All PTC patients had central lymph node metastasis.The consistency between intraoperative frozen lymph nodes pathological results and postoperative paraffin pathological results was 81.2%,and the false negative rate was 15.4%.When the number of frozen lymph nodes was more than 5,the consistency of frozen pathological results and postoperative pathological results was 93.7%,and the false negative rate was 6.3%.Conclusion:PTC lymph node metastases are more common in the central region of the neck.Frozen pathological examination of the anterior laryngeal lymph nodes,anterior tracheal lymph nodes and paratracheal lymph nodes can effectively indicate whether the lymph nodes in the central region are involved or not.When the number of lymph nodes sent for intraoperative examination is more than 5,it is more helpful to judge whether the lymph nodes in the central region are metastatic or not.Combined with the risk factors of lymph node metastasis can be designed for patients with a more accurate surgical management.