甲状腺乳头状癌颈部淋巴结转移的处理态度和诊疗现状

Treatment attitude and the status of diagnosis and treatment in neck lymph nodes of papillary thyroid cancer

甲状腺乳头状癌(Papillary thyroid carcinoma,PTC)虽以惰性居多,但颈部淋巴结转移的患者并不少见,而颈淋巴结转移的发生也意味着死亡率增加和复发风险的提高,甲状腺手术前应使用彩超充分评估颈部淋巴结的状态,对直径较大的淋巴结行超声引导下淋巴结细针抽吸(Echo-guided fine needle aspiration of the lymph node,LN-FNA)或联合测定洗脱液的甲状腺球蛋白水平,在怀疑远处转移或肿瘤浸润性生长时可联合CT、PET-CT或磁共振检查。建议临床医生在有技术保证的前提下对术中冰冻为阴性的cN0患者行单侧的预防性中央区淋巴结清扫术(Prophylactic central neck dissection,pCND),对术中冰冻为阳性的cN0患者行双侧的中央区淋巴结清扫术,在降低患者复发率的同时减少术后并发症的发生,应严格按照指南评估患者术后是否需行放射性碘治疗,以减少不必要的放射性治疗,更好地服务于患者,提升患者的生存质量。

Although papillary thyroid carcinoma(PTC)is mostly inert,patients with neck lymph node metastasis are not uncommon.The occurrence of neck lymph node metastasis in thyroid cancer also means increased mortality and increased the risk of recurrence.Before thyroid surgery,color Doppler ultrasound should be used to fully assess the status of neck lymph nodes status.Ultrasound-guided fine needle aspiration of the lymph node(LN-FNA)or combined the level of eluent thyroglobulin were used to determine large-diameter lymph nodes.CT,PET-CT or magnetic resonance examination were combined when suspected distant metastasis or invasive tumor growth.It is recommended that clinicians perform unilateral prophylactic central lymph node dissection(pCND)on cN0 patients who are negative for intraoperative frozen section diagnosis under the premise of technical guarantee,and perform double pCND for cN0 patients who are positive for intraoperative frozen section diagnosis,resulting in reducing the recurrence rate and the incidence of postoperative complications.In order to reduce unnecessary radiation therapy,better serve patients,and improve the quality of life of patients,strictly follow the guidelines are performed to evaluate whether patients need to receive RAI after surgery.