纳米炭结合术中触诊用于T1~T2期cN0单灶甲状腺乳头状癌选择性中央区淋巴结清扫的可行性分析

Feasibility analysis of carbon nanoparticles combined with intraoperative palpation in selective central neck dissection for unifocal cN0 T1-T2 papillary thyroid carcinoma

目的探讨在T1~T2期cN0单灶甲状腺乳头状癌(papillary thyroid cancer,PTC)手术中应用纳米炭结合触诊行中央区淋巴结冰冻活检,依据活检结果选择性行中央区淋巴结清扫的可行性。方法选取河北医科大学第四医院初治的T1~T2期cN0单灶PTC患者217例。术中将颈中央区纳米炭黑染淋巴结、触诊到的未黑染但质硬淋巴结分别送冰冻病理,剩余清扫组织送石蜡病理,分析三种标本淋巴结转移情况。分成两组进行对比分析,对照组为纳米炭黑染淋巴结组,试验组为纳米炭黑染淋巴结结合触诊组,主要比较两组的检出率、假阴性率以及试验组中剩余清扫组织出现淋巴结转移的影响因素。结果对照组术中冰冻淋巴结的检出率、准确度、假阴性率分别为96.8%、95.2%、11.6%,试验组为97.7%、98.6%、3.4%。两组的准确度、假阴性率差异有统计学意义(χ^(2)=3.958、4.250,P<0.05)。对试验组进行多因素分析显示术中冰冻淋巴结出现转移和术中冰冻淋巴结的阴性个数是中央区剩余清扫组织出现转移的独立影响因素(OR值=14.195、0.652,P<0.01)。结论在处理T1~T2期cN0单灶PTC颈中央区时,将纳米炭黑染淋巴结及未黑染质硬淋巴结均送术中冰冻可以获得高的检出率、准确度以及低的假阴性率。当术中冰冻淋巴结有转移时应行中央区清扫。冰冻淋巴结阴性个数越少,越要警惕剩余中央区存在淋巴结转移。

Objective To investigate the feasibility of frozen lymph node biopsy with carbon nanoparticles combined with palpation in selective central neck dissection for unifocal cN0 T1-T2 papillary thyroid cancer(PTC)based on the biopsy results.Methods A total of 217 patients with unifoal cN0 T1-T2 PTC initially treated in the Fourth Hospital of Hebei Medical University were selected.Lymph nodes with carbon black staining and palpated hard lymph nodes without black staining were sent for frozen pathology,and the remaining dissected tissues were sent for paraffin pathology to analyze lymph node metastasis of the three specimens in the central neck,and matched into two groups for comparison.The lymph nodes with carbon nanoparticles black staining were defined as the control group.The lymph nodes with carbon nanoparticles black staining combined with palpation were defined as the experimental group.The detection rate and false negative rate between the two groups,as well as the influencing factors of lymph node metastasis in the remaining dissected tissues in the experimental group,were compared.Results The detection rate,accuracy rate and false negative rate of intraoperative lymph node biopsy were 96.8%,95.2%and 11.6%in control group,respectively,and 97.7%,98.6%and 3.4%in the experimental group,respectively.There were significant differences in accuracy rate and false negative rate between two groups(χ^(2)=3.958,4.250,all P<0.05).Multivariate analysis of the experimental group showed that intraoperative frozen lymph node metastasis and the number of negative intraoperative frozen lymph nodes were independent factors influencing metastasis of the remaining dissected tissue in the central neck(OR values=14.195,0.652,all P<0.01).Conclusion In the treatment of unifocal cN0 T1-T2 PTC in the central neck,lymph nodes with carbon black staining and palpated hard lymph nodes sent for frozen biopsy can ensure high detection rate and accuracy rate,and low false negative rate.Central neck dissection should be carried out when intraoperative lymph nodes frozen are found to have metastasis.The fewer negative numbers of frozen lymph nodes,the more vigilant doctors should be of lymph node metastasis in the remaining central region.