颈内静脉肩胛舌骨肌淋巴结预测甲状腺乳头状癌颈内静脉后群淋巴结转移

Jugulo-omohyoid lymph nodes for the prediction of lymph node metastasis in the posterior jugular vein of papillary thyroid carcinoma

目的探讨颈内静脉肩胛舌骨肌淋巴结(jugulo-omohyoid lymph nodes,JOHLN)对甲状腺乳头状癌(papillary thyroid carcinoma,PTC)颈内静脉后群淋巴结转移的预警作用和临床意义。方法回顾性分析220例于本中心行侧颈清扫的患者资料,分析JOHLN与颈内静脉后群淋巴结转移的相关性。结果JOHLN预测颈内静脉后群淋巴结转移的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为83.5%,46.4%,82.0%,49.1%,74.1%,上部肿瘤JOHLN预测的准确率为84.3%;本研究有11例出现侧颈跳跃式转移,均有JOHILN转移,其中9例为上部肿瘤,2例位于中部。跳跃式转移中有6例出现颈内静脉后群淋巴结转移,且均为上部肿瘤。结论JOHLN能有效预测侧颈转移的风险。尤其是上部PTC,术前评估JOHLN,可帮助决策侧颈淋巴结清扫,减少再次手术或避免侧颈部过度治疗;对于上部肿瘤,JOHLN可能是癌细胞向侧颈转移的优先通道;JOHLN可能是上部肿瘤发生跳跃式转移的媒介。

Objective To investigate the value of jugulo-omohyoid lymph nodes(JOHLN)for the prediction of lateral cervical lymph nodes metastasis behind internal jugular vein in patients with papillary thyroid carcinoma(PTC)and its clinical significance.Methods The clinical data of 220 patients who underwent lateral neck dissection in our center were retrospectively analyzed,and the early warning effect and c linical significance of JOHLN on lymph node metastasis of the posterior internal jugular vein were analyzed.Results In this study,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of JOHLN for predicting lymph node metastasis in the posterior group of internal jugular vein were 83.5%,46.4%,82.0%,49.I%,and 74.1%,respectively.The accuracy rate for JOHLN prediction of upper tumor was 84.3%;In this study,side neck skip metastasis was found in 11 cases,all of which were JOHI.N metastasis,upper tumors were found in 9 cases and 2 were located in the middle.Among the skip metastases,6 cases had lymph node metastasis in the posterior group of internal jugular vein,and they were all upper tumors.Conclusions JOHLN can effectively predict the risk of lateral neck metastasis.Especially for the upper P rC,preoperative evaluation of JOHLN can help decision-making of lateral neck lymph node dissection.