The Number of Lymph Nodes and Relationship with Presence of Thyroiditis and Thymic Tissue in the Central Neck Dissection Materials for Thyroid Papillary Carcinoma: Pathologic Analysis

Background: Central lymph node dissection (CLND) for papillary thyroid carcinoma (PTC) allows correct pathologic staging of lymph nodes and planning of postoperative management. The purpose of this study was to determine the number of the lymph nodes in the CLND and the relationship to presence of chronic lymphocytic thyroiditis (CLT) and thymic tissue (TT). Methods: Total thyroidectomy and CLND materials from 153 patients with PTC were included in this study. Two histopathologic features (presence of CLT and TT) were evaluated for their value in adequacy of CLND. Results: Histopathologic examination revealed CLT and TT in CLND materials in 70 (46%) and 63 (41%) patients, respectively. Total number of lymph nodes in CLND materials was significantly higher in CLT (+) and TT (+) groups (p Conclusions: Our study demonstrates that presence of CLT in thyroid gland has been associated with higher number of central lymph nodes mainly due to increased number of benign hyperplastic lymph nodes. It may be possible to conclude that upper limit of lymph nodes for satisfactory CLND would be higher to correctly evaluate central lymph node status in existing staging systems if specimens have CLT. Results of this study also show that the presence of TT in surgical materials may represent the adequacy of CLND.

Neck dissection for recurrent and persistent lymph nodes of nasopharyngeal carcinoma after radiotherapy： effect and choice

Objective： To investigate the best surgical mode for the patients of nasopharyngeal carcinoma with recurrent and persistent lymph nodes after radiotherapy. Methods： The clinical data of 88 patients of nasopharyngeal carcinoma with recurrent and persistent lymph nodes after radiotherapy were analyzed retrospectively. The levels of involved lymph nodes and the relationship among the levels were analyzed; the survival rate and recurrent rate of the surgical modes including radical neck dissection （RND）, modified radical neck dissection （MRND）, selective neck dissection （SND）, and lymph node resection （LNR） were analyzed; the role of postoperative radiotherapy was evaluated. Results： （1） The recurrent and persistent lymph nodes mainly located in level Ⅱ（55.6% and 58.6%, respectively）, next was level Ⅲ and rarely in level Ⅳ, Ⅴ, and Ⅰ, but the number of levels Ⅳ Ⅴ, and Ⅰ with cancer-bearing lymph nodes was relatively more than that of clinical measurement. （2） Patients with lymph nodes involved in level Ⅲ and Ⅳ, usually, have other levels involved simultaneously; the percentages were 63.6% and 88.9%, respectively. However, the lymph nodes in level Ⅱ and Ⅴ were mainly isolated. （3） The 5-year survival rate and recurrent rate of the whole group were 42.77% and 22.7%, respectively. （4） The 5-year survival rates of RND, MRND, SND, and LMR groups were 39.75%, 60.00%, 37.87%, and 44.10%, respectively; the differences were insignificant （Log-rank = 1.0, P = 0.8011）; the recurrent rate between the extensive and local surgery groups were insignificant （X^2 = 0.470, P = 0.493）. （5） The 5-year survival rates of the patients with and without postoperative radiotherapy were 39.06% and 45.26%, respectively; the difference was insignificant （Log-rank = 0.06, P = 0.8138）. Conclusion： The extensive surgery was recommended when the recurrent and persistent lymph nodes were more than one level involved or very large or immovable, otherwise, the SND should be performed and postoperative radiotherapy was important compensation if necessary.

A new device for the identification of lymph nodes removed during different types of neck dissection

Meticulous mapping of the lymph node status is a general principle in present-day head and neck surgery. The removal of a certain number of lymphatic levels during neck dissection may well be therapeutic in intent, but it is also mandatory for correct tumour staging. We pre- sent a precise lymph node mapping during dif- ferent types of neck dissection in the course of major head and neck surgery by a sterile plastic tray moulded in the shape of the neck. This de- vice makes lymph node mapping simpler, safer, quicker and methodically more structured than any of the present methods. It facilitates the work of the pathologist and the flow of reliable information along the surgeon-pathologist- oncologist chain. With this device, a more stru- ctured, methodical means of lymph node removal has become possible.

Accuracy of Ultrasound Examination of Loco-Regional Lymph Nodes in Breast Cancer Follow-Up and Its Role in the Axillary Surgical Management

Objective: Major international guidelines have not standardized the sequence of diagnostic examinations during the follow-up of a patient with a diagnosed breast cancer. The aim of this study is to investigate the accuracy of sonography in the diagnosis of loco-regional lymphatic recurrences in comparison to the core needle biopsy results. Materials and Methods: Among 6455 patients who were followed up with clinical examination, mammography and ultrasound between January 2004 and November 2011, 125 (1.93%) patients had to be investigated with a core needle biopsy of a sonographically suspicious loco-regional lymph node. Results: Among the whole series, a total of 142 ultrasound-guided core needle biopsies were performed. Follow-up for the primary tumor lasted for a median time of 6.1 years (range 1 - 27 years). Ultrasound of suspicious loco-regional lymph nodes showed a sensitivity of 89.5%, a specificity of 87.1% and a positive predictive value of 89.5%. Conclusions: In our experience, ultrasound of suspicious loco-regional lymph nodes showed good accuracy and it should be a part of the standard examinations performed during follow-up for breast cancer.

Nonintubated thoracoscopic lobectomy plus lymph node dissection following segmentectomy for central type pulmonary masses

Lung cancer is the most common cancer worldwide. In the United States, it causes more cancer-related deaths than the next four causes （breast cancer, prostate cancer, colon cancer, and pancreatic cancer） of cancer-related mortality combined （1）. About 30% of people have already progressed to stage III lung cancer and 40% to stage IV at the time they are diagnosed （2）. Although chest X-ray and sputum cytology, when applied in health check-ups, can identify some relatively small tumors, they are not able to lower the overall mortality （3）. More recently,

Clinical value of regional lymph node sorting in gastric cancer

BACKGROUND Increasing evidence have shown that regional lymph node metastasis is a critical prognostic factor in gastric cancer(GC).In addition,lymph node dissection is a key factor in determining the appropriate treatment for GC.However,the association between the number of positive lymph nodes and area of lymph node metastasis in GC remains unclear.AIM To investigate the clinical value of regional lymph node sorting after radical gastrectomy for GC.METHODS This study included 661 patients with GC who underwent radical gastrectomy at Tianjin Medical University General Hospital between January 2012 and June 2020.The patients were divided into regional sorting and non-sorting groups.Clinicopathological data were collected and retrospectively reviewed to determine the differences in the total number of lymph nodes and number of positive lymph nodes between the groups.Independent sample t-tests were used for intergroup comparisons.Continuous variables that did not conform to a normal distribution were expressed as median(interquartile range),and the Mann-Whitney U test was used for inter-group comparisons.RESULTS There were no significant differences between the groups in terms of the surgical method,tumor site,immersion depth,and degree of differentiation.The total number of lymph nodes was significantly higher in the regional sorting group(n=324)than in the non-sorting group(n=337)(32.5 vs 21.2,P<0.001).There was no significant difference in the number of positive lymph nodes between the two groups.A total of 212 patients with GC had lymph node metastasis in the lymph node regional sorting group,including 89(41.98%)cases in the first dissection station and 123(58.02%)cases in the second dissection station.Binary and multivariate logistic regression results showed that the number of positive lymph nodes(P<0.001)was an independent risk factor for lymph node metastases at the second dissection station.CONCLUSION Regional sorting of lymph nodes after radical gastrectomy may increase the number of detected lymph nodes,thereby improving the reliability and accuracy of lymph node staging in clinical practice.

On the road to standardization of D2 lymph node dissection in a European population of patients with gastric cancer

The amount of lymph node dissection(LD) required during surgical treatment of gastric cancer surgery has been quite controversial.In the 1970 s and 1980 s,Japanese surgeons developed a doctrine of aggressive preventive gastric cancer surgery that was based on extended(D2) LD volumes.The West has relatively lower incidence rates of gastric cancer,and in Europe and the United States the most common LD volume was D0-1.This eventually caused a scientific conflict between the Eastern and Western schools of surgical thought.:Japanese surgeons determinedly used D2 LD in surgical practice,whereas European surgeons insisted on repetitive clinical trials in the European patient population.Today,however,one can observe the results of this complex evolution of views.The D2 LD is regarded as an unambiguous standard of gastric cancer surgical treatment in specialized European centers.Such a consensus of the Eastern and Western surgical schools became possible due to the longstanding scientific and practical search for methods that would help improve the results of gastric cancer surgeries using evidence-based medicine.Today,we can claim that D2 LD could improve the prognosis in European populations of patients with gastric cancer,but only when the surgical quality of LD execution is adequate.

Sentinel Lymph Node Biopsy as Guidance for Lateral Neck Dissection in Patients with Papillary Thyroid Carcinoma

Introduction: The surgical management of lateral lymph nodes in differentiated thyroid carcinoma is controversies. Therefore, we analyzed whether sentinel lymph nodes (SLN) biopsy of the first draining nodes in the jugulo-carotid chain is an accurate technique to select patients with true-positive but nonpalpable lymph nodes for selective lateral node dissection. Materials and Methods: From January 2009 to December 2009, 12 patients with solitary papillary carcinoma measuring 2 cm by ultrasonography were included in this study. After the thyroid gland was exposed to avoid injuring the lateral thyroid lymphatic connection, approximately 0.2 ml of 5mg/ml indocyanine green was injected into the parenchyma of upper and lower thyroid gland. Some stained lymph nodes in the jugulo-carotid chain could be identified following the stained lymphatic duct and dissected as the SLN. After that, thyroidectomy with modified neck dissection was performed. Results: The mean tumor size was 22.1 ± 4.6 mm. Identification and biopsy of stained SLN in the ipsilateral jugulo-carotid chain was successful in all 12 cases. In 6 cases, histopathological analysis of SLNs revealed metastases of the papillary thyroid carcinoma. Among them, 2 cases had additional metastatic lymph nodes in the ipsilateral compartment. Of the 6 patients who had negative lymph node metastasis (LNM) in SLNs, all patients had negative LNM in the ipsilateral compartment. Conclusions: The method may be helpful in the detection of true-positive but nonpalpable lymph nodes and may support a decision to perform a selective lateral node dissection in patients with papillary thyroid carcinoma.

A review of clinical and histological parameters associated with contralateral neck metastases in oral squamous cell carcinoma

Oral squamous cell carcinoma （OSCC） has a high incidence of cervical micrometastases and sometimes metastasizes contralaterally because of the rich lymphatic intercommunications relative to submucosal plexus of oral cavity that freely communicate across the midline, and it can facilitate the spread of neoplastic cells to any area of the neck consequently. Clinical and histopathologic factors continue to provide predictive information to contralateral neck metastases （CLNM） in OSCC, which determine prophylactic and adjuvant treatments for an individual patient. This review describes the predictive value of clinical-histopathologic factors, which relate to primary tumor and cervical lymph nodes, and surgical dissection and adjuvant treatments. In addition, the indications for elective contralateral neck dissection and adjuvant radiotherapy （aRT） and strategies for follow-up are offered, which is strongly focused by clinicians to prevent later CLNM and poor prognosis subsequently.

Predictive factors for central lymph node metastases in papillary thyroid microcarcinoma

Papillary thyroid microcarcinoma(PTMC)measures 1 cm or less in its longest dimension.The incidence of PTMC is increasing worldwide.Surgery is the primary treatment;however,prophylactic central lymph node dissection is controversial,and discrepancies between different guidelines have been noted.Routine prophylactic central lymph node dissection may result in hypoparathyroidism and recurrent laryngeal nerve injury in some patients without lymph node metastasis,while simple thyroidectomy may leave metastatic lymph nodes in high-risk patients.To selectively perform prophylactic lymph node dissections in high-risk patients,it is important to identify predictive factors for lymph node metastases in patients with PTMC.Several studies have reported on this,but their conclusions are not entirely consistent.Several clinicopathologic characteristics have been identified as risk factors for central lymph node metastases,and the most commonly reported factors include age,gender,tumor size and location,multifocality,bilaterality,extrathyroidal extension,and abnormal lymph node found using ultrasound.Here,we provide an overview of previous studies along with a favorable opinion on or against these factors,with the aim of increasing the understanding of this topic among the medical community.In addition,current opinions about prophylactic central lymph node dissection are reviewed and discussed.

Lingual lymph nodes:Anatomy,clinical considerations,and oncological significance

Lingual lymph nodes are an inconstant group of in-transit nodes,which are located on the route of lymph drainage from the tongue mucosa to the regional nodes in neck levels I and II.There is growing academic data on the metastatic spread of oral cancer,particularly regarding the spreading of oral tongue squamous cell carcinoma to lingual nodes.These nodes are not currently included in diagnostic and treatment protocols for oral tongue cancer.Combined information on surgical anatomy,clinical observations,means of detection,and prognostic value is presented.Anatomically obtained incidence of lingual nodes ranges from 8.6%to 30.2%.Incidence of lingual lymph node metastasis ranges from 1.3%to 17.1%.It is clear that lymph nodes that bear intervening tissues from the floor of the mouth should be removed to improve loco-regional control.Extended resection volume,which is required for the surgical treatment of lingual node metastasis,cannot be implied to every tongue cancer patient.As these lesions significantly influence prognosis,special efforts of their detection must be made.Reasonably,every tongue cancer patient must be investigated for the existence of lingual lymph node metastasis.Lymphographic tracing methods,which are currently implied for sentinel lymph node biopsies,may improve the detection of lingual lymph nodes.

OCCULT CERVICAL METASTASIS OF SQUAMOUS CELL CARCINOMA OF TONGUE AMONG CN0 PATIENTS AND ITS TREATMENT

Objective： To explore the treatment of clinically negative neck （CN0） patients with squamous cell carcinoma of the tongue. Methods： 165 CN0 patients with squamous cell carcinoma of the tongue from 1985 to 2002 were investigated retrospectively. Parts of the patients staged at T1, T2 and T3 underwent resection of primary lesion followed by neck observation, and other patients staged above T2 or at T1 but without follow-up were treated with elective neck dissection （END）. All patients were followed up for more than 3 y or until their death. Results： Lymphatic metastasis was identified histologically after operation in 33 of 120 patients treated with END, and 9 of 45 patients treated with resection of primary lesion alone. The overall rate of occult lymphatic metastasis was 25.45%, which increased with the elevating of clinical T stage. The overall rate of neck uncontrolled death was 20.00% for observation group and 5.00% for END group, and significant difference was found between them （P〈0.05）. For T~ patients in the two groups, the rate of neck uncontrolled death was 7.71% and 4.00% respectively, and no significance was found between them （P〉0.05）. When stage T2 and T3 were considered as middle stage together, significant difference （P〈0.05） could be obtained between observation （70.00%） and END group （0%）. Conclusion： The occult metastasis rate of squamous cell carcinoma of tongue increases with the elevating of clinical stage, and elective neck dissection could be considered for NO patients staged over T2 to improve neck control and survival rate; and regional resection alone of primary lesion could be considered for T1N0 patients to improve quality of life if closely followed up is conducted.

Comparative Study between Robotic Total Thyroidectomy with Central Lymph Node Dissection via Bilateral Axillo-breast Approach and Conventional Open Procedure for Papillary Thyroid Microcarcinoma

Background： A large proportion of the patients with papillary thyroid microcarcinoma are young women. Therefore, minimally invasive endoscopic thyroidectomy with central neck dissection （CND） emerged and showed well-accepted results with improved cosmetic outcome, accelerated healing, and comforting the patients. This study aimed to evaluate the safety and effectiveness of robotic total thyroidectomy with CND via bilateral axillo-breast approach （BABA）, compared with conventional open procedure in papillary thyroid microcarcinoma. Methods： One-hundred patients with papillary thyroid microcarcinoma from March 2014 to January 2015 in Jinan Military General Hospital of People＇s Liberation Army （PLA） were randomly assigned to robotic group or conventional open approach group （17 = 50 in each group）. The total operative time, estimated intraoperative blood loss, numbers of lymph node removed, visual analog scale （VAS）, postoperative hospital stay time, complications, and numerical scoring system （NSS, used to assess cosmetic effect） were analyzed. Results： The robotic total thyroidectomy with CND via BABA was successfully performed in robotic group. There were no conversion from the robotic surgeries to open or endoscopic surgery. The subclinical central lymph node metastasis rate was 35%. The mean operative time of the robotic group was longer than that of the conventional open approach group （118.8± 16.5 min vs. 90.7± 10.3 min, P 〈 0.05）. The study showed significant differences between the two groups in terms of the VASs （2.1 ± 1.0 vs. 3.8 ±~ 1.2, P 〈 0.05） and NSS （8.9 ± 0.8 vs. 4.8 ± 1.7, P 〈 0.05）. The differences between the two groups in the estimated intraoperative blood loss, postoperative hospital stay time, numbers of lymph node removed, postoperative thyroglobulin levels, and complications were not statistically significant （all P 〉 0.05）. Neither iatrogenic implantation nor metastasis occurred in punctured porous channel or chest wall in both groups. Postoperative cosmetic results were very satisfactory in the robotic group. Conclusions： Robotic total thyroidectomy with CND via BABA is safe and effective for Chinese patients with papillary thyroid microcarcinoma who worry about the neck scars.

Elective neck dissection in oral squamous cell carcinoma of the upper maxilla:necessary?

Aim:Surgical treatment of clinically negative neck in maxillary squamous cell carcinoma(SCC)of the upper jaw is controversial.The purpose of this systematic review was to define the incidence of cervical metastasis and to assess if elective neck dissection is justified when the neck is not primarily affected.Methods:An electronic literature search was conducted in several databases,including MEDLINE,EMBASE,and Cochrane Central databases,for articles written in English.Results:Twenty-eight articles were included in the review.The overall cervical metastases rate was 33%and the total initial cervical metastases rate was 16%.Interestingly,the author found that 71%of patients with cervical metastases from maxillary SCC carcinoma were T3/T4 stage.Conclusion:This review shows the need for a change in the management of the N0 neck in SCC arising in the maxillary alveolus and hard palate.Elective neck dissection should be performed in patients with T3/T4 tumours with clinic or radiographic negative necks(N0c).

改良式小切口病灶清除术联合功能性颈淋巴结清扫术对颈部淋巴结核的治疗效果观察

目的探讨改良式小切口病灶清除术联合功能性颈淋巴结清扫术(FND)治疗颈部淋巴结核的临床效果。方法选取2020年8月至2022年8月河北省胸科医院普外科收治的颈部淋巴结核患者104例,采用随机数字表法分为观察组和对照组,每组52例。观察组采用改良式小切口病灶清除术联合FND治疗,对照组采用常规切口病灶清除术联合FND治疗。比较两组的治疗效果、手术相关指标、切口愈合情况、术后疼痛程度及并发症发生情况。结果两组治疗总有效率比较差异无统计学意义(P>0.05)。观察组术中出血量少于对照组,手术时间、切口长度、引流管拔除时间、住院时间、切口瘢痕长度、切口愈合时间短于对照组,切口愈合良好率高于对照组,术后12、24、48、72 h静息及活动状态下的疼痛视觉模拟量表评分低于对照组,差异均有统计学意义(P<0.05)。观察组术后并发症发生率为3.85%,明显低于对照组的17.31%,差异有统计学意义(P<0.05)。结论改良式小切口病灶清除术联合FND治疗颈部淋巴结核可促进术后恢复及切口愈合,减轻术后疼痛,且并发症较少,值得临床应用。

无充气腋窝入路和颈前开放入路甲状腺癌根治术对甲状旁腺功能及中央区淋巴结清扫水平的影响

目的:比较无充气腋窝入路和颈前开放入路甲状腺癌根治术对甲状旁腺功能及中央区淋巴结清扫水平的影响。方法:回顾性分析2021年1月至2022年6月我院收治的80例甲状腺乳头状癌患者的临床资料,其中40例行颈前开放入路甲状腺癌根治术(开放组),40例行无充气腋窝入路甲状腺癌根治术(腋窝组),对比两组术前和术后血清全段甲状旁腺激素(siPTH)水平、血清钙水平及中央区淋巴结清扫个数。结果:两组术前siPTH和血清钙水平比较差异无统计学意义(P>0.05),两组术后siPTH水平虽有降低,但均在正常范围,两组术后血清钙均值也在正常范围,两组术后siPTH及血清钙水平比较差异无统计学意义(P>0.05)。开放组中央区淋巴结清扫数量多于腋窝组(P<0.05)。结论:两种入路甲状腺癌根治术对甲状旁腺功能的影响无明显差异,但传统颈前开放入路术式较无充气腋窝入路术式对清扫中央区淋巴结更有利。

甲状腺乳头状癌超声图像表现在预测颈部Ⅵ区淋巴结转移危险度的临床价值

目的 分析甲状腺乳头状癌(PTC)超声图像表现在预测颈部Ⅵ区淋巴结转移(lymph node metastasis in the cervicalregion Ⅵ,CLNM-Ⅵ)危险度的临床价值。方法 选取2022年4月~2023年6月在河北省沧州中西医结合医院接受手术治疗并经病理证实的350例PTC患者,根据术后病理结果,将患者分为CLNM-Ⅵ组和非CLNM-Ⅵ组。收集并对比两组术前超声图像表现及临床病理特征,应用Logistic回归分析PTC患者CLNM-Ⅵ危险因素,受试者工作特征(ROC)曲线分析PTC超声图像表现对CLNM-Ⅵ的预测价值。结果 单因素分析显示,CLNM-Ⅵ组男性、实性或囊实性、年龄≤45岁、低回声、甲状腺背景正常、点状强回声的构成比均大于非CLNM-Ⅵ组(P均<0.05)。Logistic回归分析显示,男性、实性或囊实性、年龄≤45岁、低回声、甲状腺背景正常、病灶内可见点状强回声是CLNM-Ⅵ的独立危险因素(P均<0.05);进一步经ROC曲线分析显示,以上预测CLNM-Ⅵ的AUC分别为0.565、0.580、0.529、0.585、0.582、0.582,联合预测AUC为0.708。结论PTC超声图像表现在CLNM-Ⅵ风险评估中具有重要意义,可为PTC的预后判断提供一定的参考依据。

神经探测在甲状腺全切术及中央区淋巴结清扫术中的应用及对喉返神经的保护作用分析

目的探讨神经监测技术在甲状腺全切术及中央区淋巴结清扫术中的应用效果。方法回顾性分析2017年1月至2023年1月在贵州航天医院行甲状腺全切术的100例甲状腺肿瘤患者为研究对象,按照术中是否使用神经探测分为观察组和常规显露组,每组各50例。观察组术中实施喉返神经监测技术,常规显露组术中常规显露喉返神经。记录两组手术指标(手术时间、术中出血量、引流管拔管时间和术后住院时间),比较两组手术前后的简化嗓音障碍指数(VHI-10)评分、声带功能指标、血清甲状旁腺素、钙水平及永久性喉返神经损伤发生率、暂时性喉返神经损伤发生率。结果两组手术时间、术中出血量、引流管拔管时间和术后住院时间比较,差异均无统计学意义(P>0.05)。观察组术后VHI-10评分为(1.18±0.38)分,低于常规显露组[(1.97±0.61)分],差异有统计学意义(P<0.05)。观察组术后谐波噪声比为(25.61±6.07)dB,高于常规显露组[(19.07±4.53)dB],振幅微扰、基频微扰和基频分别为(1.67±0.22)%、(0.20±0.04)%、(132.36±14.23)Hz,均低于常规显露组[(1.67±0.22)%、(0.20±0.04)%、(132.36±14.23)Hz],差异均有统计学意义(P<0.05)。观察组术后血清甲状旁腺素、钙水平分别为(32.46±4.82)μg/L、(2.08±0.48)mmol/L,均高于常规显露组[(18.79±3.05)μg/L、(1.85±0.22)mmol/L],差异均有统计学意义(P<0.05)。观察组暂时性喉返神经损伤发生率为0,低于常规显露组(8.00%),差异有统计学意义(P<0.05),永久性喉返神经损伤发生率比较,差异无统计学意义(P>0.05)。结论神经探测在甲状腺全切术及中央区淋巴结清扫术中的应用效果确切,能够有效改善嗓音及声带功能,保护喉返神经,减少暂时性喉返神经损伤发生,应用价值较高。

预测甲状腺乳头状癌颈部中央区淋巴结转移生物标志物研究进展

甲状腺癌作为常见的内分泌恶性肿瘤,发病率逐年上升。甲状腺乳头状癌作为其中最常见的病理分型,大部分病人预后较好,但颈部淋巴结转移作为其侵袭性特征,提示病人预后不良。目前国内外指南对于术前颈部淋巴结无明显转移征象病人是否需预防性行颈部中央区淋巴结清扫存在争议。液体活检具有便捷、无创等特点,多种血清标志物及基因突变靶点在甲状腺乳头状癌颈部淋巴结转移中的作用具有独特优势,并可联合影像学检查及细针穿刺活检提高诊断敏感性,但仍有不足之处。该研究就甲状腺乳头状癌颈部中央区淋巴结转移相关的部分生物标志物进行综述。

甲状腺上极乳头状癌侧颈区淋巴结转移的危险因素

目的 探讨甲状腺上极乳头状癌患者侧颈区淋巴结转移的相关危险因素,对于术前未发现侧颈区转移但存在危险因素的甲状腺上极乳头状癌患者,为其在术中进行侧颈区淋巴结转移的评估提供理论依据。方法 回顾性分析甲状腺上极乳头状癌194例患者的临床资料,单因素和多因素分析侧颈区淋巴结转移的独立危险因素。结果 单因素分析显示,肿瘤Braf基因、中央区淋巴结转移数目、纵横比、内部回声、内部钙化、血流信号、肿瘤大小、被膜被侵犯与甲状腺上极乳头状癌侧颈区淋巴结转移有关,P<0.05;多因素分析显示,中央区淋巴结转移数目>3、肿瘤大小为11~20 mm、纵横比>1、内部钙化、内部回声不均匀为侧颈区淋巴结转移的独立危险因素。结论 甲状腺上极乳头状癌患者中央区淋巴结转移数目、纵横比、内部钙化、内部回声、肿瘤大小是侧颈区淋巴结转移独立危险因素,对于术前未发现侧颈区转移但存在危险因素的甲状腺上极乳头状癌患者,在术中可积极进行侧颈区淋巴结转移的评估,必要时可行术中侧颈区淋巴结快速病理检查。