术中探查对指导cN0期甲状腺乳头状微小癌中央区淋巴结清扫的价值

The Value of Intraoperative Exploration in Guiding Central Lmph Node Dissection in Stage cN0 Thyroid Papillary Microcarcinoma

目的:探讨术中探查对指导cN0期甲状腺乳头状微小癌(TPMC)中央区淋巴结清扫的价值。方法:选取福建省立金山医院2017年1月至2020年1月收治的922例cN0期TPMC患者作为研究对象,中央区淋巴结是否存在转移以术后病理结果作为金标准,计算外科医生术中探查对中央区淋巴结转移的诊断效能,并分析最大转移淋巴结大小、转移淋巴结数目对诊断结果的影响。结果:本研究922例TPMC患者中,术后石蜡病理检查发现302例(32.8 %)中央区淋巴结转移。术中探查诊断中央区转移性淋巴结的灵敏度为23.84 %、特异度为77.26 %、阳性预测值为33.80 %、阴性预测值为67.56 %。最大转移淋巴结直径≥5 mm患者的术中探查假阴性率显著低于最大转移淋巴结直径<5 mm的患者,差异具有统计学意义(P<0.001)。不同转移淋巴结数目患者的术中探查假阴性率比较,差异无统计学意义(P>0.05)。结论:术中探查诊断cN0期TPMC中央区淋巴结转移的灵敏度及特异度均较低,因此,术中探查指导cN0期TPMC中央区淋巴结清扫的价值有限。

Objective To investigate the value of intraoperative exploration in guiding central lymph node dissection of Stage cN0 thyroid papillary microcarcinoma (TPMC).Methods A total of 922 patients with TPMC stage cN0 admitted to Fujian Provincial Jinshan Hospital from January 2017 to January 2020 were selected as the research subjects.The existence of lymph node metastasis in central region was determined by using postoperative pathological results as the gold standard to calculate the diagnostic efficacy of surgeons’ intraoperative exploration for lymph node metastasis in central region.The maximum size of metastatic lymph nodes and the number of metastatic lymph nodes were analyzed.Results In this study,out of the 922 TPMC patients,302 cases (32.8 %) had lymph node metastasis in the central region.The sensitivity,specificity,positive predictive value and negative predictive value were 23.84 %,77.26 %,33.80 % and 67.56 % respectively.The false negative rate of intraoperative exploration in patients with the largest metastatic lymph node diameter ≥ 5 mm was significantly lower than that in patients with the largest metastatic lymph node diameter < 5 mm,the difference was statistically significant (P < 0.001).There was no significant difference in the false negative rate of intraoperative exploration among patients with different number of metastatic lymph nodes (P > 0.05).Conclusion The sensitivity and specificity of intraoperative exploration in the diagnosis of lymph node metastasis in the central region of stage cN0 TPMC are both low.Therefore,the value of intraoperative exploration in guiding lymph node dissection in the central region of stage cN0 TPMC is limited.