Papillary Microcarcinoma of the Thyroid: Predicting Factors of Lateral Neck Node Metastasis
Papillary Microcarcinoma of the Thyroid: Predicting Factors of Lateral Neck Node Metastasis
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DOI：
10.1245/s10434-009-0384-x
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发表时间：
2009-05-01
影响因子：
3.7
通讯作者：
Nam, Kee-Hyun
中科院分区：
文献类型：
--
作者：
Kwak, Jin Young;Kim, Eun-Kyung;Nam, Kee-Hyun
术前预测外侧淋巴结转移（LNM）对预防复发具有重要意义；然而，很少有发表的数据预测手术前侧边淋巴结转移的因素。本研究探讨影响甲状腺乳头状微癌（PTMC）患者LNM的因素。对2004年至2006年间671例PTMC患者的数据进行了回顾性队列研究。我们回顾了患者的临床、超声（US）和病理记录，并分析了外侧LNM与临床因素、PTMC的US特征和病理特征的关系。671例ptmc患者中，外侧LNM发生率为3.7%。我们发现，在多因素分析中，外侧LNM与PTMC的US特征（上极位置、> 25%与邻近囊接触、存在钙化）和病理特征（中枢性LNM）之间存在统计学意义上的关联（P < 0.05）。在上极位置、>与邻近包膜接触25%、US上存在钙化和病理性中央LNM时，具有统计学意义因素的比值比分别为4.7（95%可信区间[95% CI]， 1.8-12.6）、10.8 （95% CI, 3.3-34.6）、4.8 （95% CI, 1.6-13.7）和6.9 （95% CI, 2.4-20）。在PTMC患者中，预测外侧LNM的独立因素是PTMC的US特征（上极位置，> 25%与邻近囊接触，存在钙化）和病理特征（中枢性LNM）。当术前超声检查发现这些特征时，应采用多模式入路仔细评估侧颈淋巴结。
Preoperative prediction of lateral lymph node metastasis (LNM) is important to prevent recurrence; however, there are few published data in predicting factors of lateral LNM before surgery. The present study investigated the factors affecting LNM in patients with papillary thyroid microcarcinoma (PTMC).A retrospective cohort study was conducted with data obtained from 671 patients with PTMC between 2004 and 2006. We reviewed the clinical, ultrasound (US), and pathology records of patients and analyzed the association between lateral LNM and clinical factors, US features of PTMC, and pathologic features.The rate of lateral LNM was 3.7% in 671 PTMCs. We found a statistically significant association between lateral LNM and US features of PTMC (upper pole location, contact of > 25% with the adjacent capsule, and presence of calcifications), and pathologic features (central LNM) in multivariate analysis (P < .05). The odds ratios of statistically significant factors were 4.7 (95% confidence interval [95% CI], 1.8-12.6), 10.8 (95% CI, 3.3-34.6), 4.8 (95% CI, 1.6-13.7), and 6.9 (95% CI, 2.4-20) at upper pole location, contact of > 25% with the adjacent capsule, presence of calcifications on US, and pathologic central LNM, respectively.In patients with PTMC, independent factors in predicting lateral LNM were US features of PTMC (upper pole location, > 25% contact with the adjacent capsule, and presence of calcifications) and pathologic features (central LNM). When these US features are detected on preoperative US, lateral neck nodes should be meticulously evaluated by a multimodal approach.