峡部甲状腺微小乳头状癌临床病理分析

Clinicopathological analysis of papillary thyroid microcarcinoma in isthmus

目的:探讨峡部甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)的临床病理特征.方法:回顾性分析经手术并经病理证实的477例PTMC临床病理资料,比较位于峡部与侧叶PTMC之间的差异.结果:多因素分析显示结节包膜接触(30.5%比10.4%,P=0.001)、淋巴结转移(lymph node metastasis,LNM)(42.7%比18.7%,P<0.001)在峡部与侧叶PTMC之间差异有统计学意义.与侧叶PTMC相比,峡部PTMC更易于出现同侧中央LNM(41.5%比17.5%,P<0.001)、同侧侧方LNM(8.5%比2.8%,P=0.022)和双侧中央LNM(12.2%比0.2%,P<0.001)以及对侧侧方LNM(3.7%比0,P<0.001).结论:与侧叶PTMC相比,峡部PTMC有更高比例的包膜接触及LNM,建议行双侧中央淋巴结清扫.

Objective To evaluate the clinicopathological characteristics of papillary thyroid microcarcinoma(PTMC) located in the isthmus. Methods The clinical and pathological data of 477 cases with PTMC diagnosed pathologically were retrospectively analyzed. Differences in PTMC between isthmus and lateral lobe were compared. Results Multivariate analysis showed that there were significantly difference in cancer capsule contact(30.5% vs. 10.4%, P =0.001) and lymph node metastasis(LNM)(42.7% vs. 18.7%, P <0.001) of PTMC between isthmus and lateral lobe.When compared with PTMC in lateral lobe, PTMC in isthmus was more prone to in ipsilateral central LNM(41.5% vs.17.5%, P<0.001), ipsilateral lateral LNM(8.5% vs. 2.8%, P=0.022) and bilateral central LNM(12.2% vs. 0.2%, P<0.001), and contralateral lateral LNM(3.7% vs. 0, P<0.001). Conclusions PTMC in isthmus had capsular contact and LNM with higher proportion compared with PTMC in lateral lobe. It should suggest bilateral central lymph node dissec-tion for PTMC located in isthmus.