Accuracy of the Lymph Node Yield in Surgery for Papillary Thyroid Cancer in Children.
Accuracy of the Lymph Node Yield in Surgery for Papillary Thyroid Cancer in Children.
复制标题
儿童甲状腺乳头状癌手术中淋巴结产量的准确性。
DOI：
10.1007/s00268-021-06207-z
复制
发表时间：
2021
影响因子：
2.6
通讯作者：
Roman,Sanziana
中科院分区：
文献类型：
--
作者：
Yap,Ava;Shui,Amy;Gosnell,Jessica;Huang,Chiung-Yu;Sosa,JulieAnn;Roman,Sanziana
Introduction我们的目的是确定接受甲状腺切除术的儿科患者的淋巴结产量（LNY）的准确性，同时收集临床淋巴结阴性（cN 0）乳头状甲状腺癌（PTC）。方法在1998-2016年的NCDB中对接受甲状腺切除术的年龄≤ 18岁的cN 0 PTC患者进行了审查。比较≥ 1例LNY患者与无LNY患者的人口统计学和临床特征。采用截尾β-二项分布估计检测病理性淋巴结阳性所需的淋巴结数量，LNY在淋巴结分期中的敏感性为90%，并根据临床肿瘤大小分期（T）进行分层。结果1,948例cN 0 PTC患儿接受手术切除，中位年龄为17岁，83.2%为女性; 47.6%为T1，25.3%为T2，9.3%为T3。这些患者中有1，272例（65.3%）进行了淋巴结切除或≥ 1个LNY。中位LNY为5个淋巴结（四分位数间距2-12）; 45.9%的患者有≥ 1个转移性淋巴结。在总体≥ 1个LNY队列中，需要12个淋巴结（CI 9-19）来预测淋巴结阳性，灵敏度> 90%。以临床T分期为基础，敏感性> 90%的淋巴结转移的LNY为T1 = 14，T2 = 8，T3 = 6。结论本研究首次对cN 0型PTC淋巴结转移的LNY进行了评估。小T1肿瘤所需的高LNY可能是不可行的，不应该追求。对于较高的T级，精度随着LNY的降低而提高。我们的研究结果可以帮助指导PTC儿科患者的预后和治疗。
IntroductionOur aim was to determine the accuracy of lymph node yield (LNY) for pediatric patients undergoing thyroidectomy with concurrent lymph nodes harvest for clinically node-negative (cN0) papillary thyroid cancer (PTC).MethodsPatients aged ≤ 18 years with cN0 PTC undergoing thyroidectomy were reviewed in the NCDB, 1998–2016. Demographic and clinical characteristics of patients with ≥ 1 LNY were compared to those without. A truncated beta-binomial distribution estimated the number of lymph nodes needed to detect pathologic nodal positivity, and LNY was calibrated for 90% sensitivity in nodal staging and stratified across clinical tumor size staging (T).Results1,948 children with cN0 PTC underwent surgical resection; median age was 17 years; 83.2% were female; 47.6% were T1, 25.3% T2, 9.3% T3. 1,272 (65.3%) of these patients had lymph nodes resected, or ≥ 1 LNY. The median LNY was 5 nodes (interquartile range 2–12); 45.9% of patients had ≥ 1 metastatic lymph nodes. In the overall ≥ 1 LNY cohort, 12 nodes (CI 9–19) were needed to predict nodal positivity with > 90% sensitivity. Based on clinical T-stage, detecting a metastatic lymph node with > 90% sensitivity required a LNY of 14 for T1; 8 for T2; 6 for T3.ConclusionThis is the first study estimating the necessary LNY for determining nodal positivity in children with cN0 PTC. The high LNY required in small T1 tumors is likely infeasible and should not be pursued. Accuracy increases with lower LNYs for higher T-stages. Our findings can help guide prognosis and treatment for pediatric patients with PTC.