Lymph node metastasis from 259 papillary thyroid microcarcinomas - Frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection
Lymph node metastasis from 259 papillary thyroid microcarcinomas - Frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection
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DOI：
10.1097/00000658-200303000-00015
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发表时间：
2003-03-01
影响因子：
9
通讯作者：
Takanashi, Y
中科院分区：
文献类型：
--
作者：
Wada, N;Duh, QY;Takanashi, Y
目的了解甲状腺乳头状微癌（PTMC）淋巴结转移的频率、类型及淋巴结清扫的效果，探讨该类患者的最佳颈部清扫策略。背景资料大多数ptmc预后良好，但少数表现为可触及的淋巴结病变。LNM患者有淋巴结复发的风险，尽管他们没有更高的死亡率。PTMC的LNM的频率和模式以及淋巴结清扫的结果尚未得到很好的确定。方法根据原发肿瘤的大小和部位，对259例PTMCs中LNM的发生频率和类型进行分析。在259例患者中，24例有可触及淋巴结的患者接受了治疗性淋巴结清扫，另外235例无可触及淋巴结的患者接受了预防性淋巴结清扫。作者比较了治疗组和预防组淋巴结清扫的结果，以及小于或等于5mm ptmc和大于5mm ptmc的结果。作者还比较了预防组和无淋巴结清扫组（155例ptmc）的淋巴结复发率。结果64.1%（166/259）和44.5%（93/209）患者的淋巴结累及正中室和同侧外侧室。气管前颈静脉（43.2%）、同侧中央颈静脉（36.3%）和同侧中下颈静脉（37.8%）更为常见。治疗组的LNM发生率高于预防组（中央室95.8% vs. 60.9%，同侧外侧室83.3% vs. 39.5%）。治疗组结节复发率高于预防组（16.7% vs. 0.43%），但预防组与未切除组无差异（0.43% vs. 0.65%）。肿瘤大小不影响淋巴结复发。淋巴结复发优先发生在同侧颈中下淋巴结。结论PTMC伴可触及淋巴结病变的患者应行治疗性淋巴结清扫术。预防性淋巴结清扫对于没有可触及淋巴结病变的患者是无益的。
Objective To determine the frequency and pattern of lymph node metastasis (LNM) from papillary thyroid microcarcinoma (PTMC) and the results of node dissection, and to establish the optimal strategy for neck dissection in these patients.Summary Background Data Most PTMCs carry a favorable prognosis, but a few present with palpable lymphadenopathy. Patients with LNM are at risk for nodal recurrence, although they do not have higher mortality. The frequency and pattern of LNM from PTMC and the results of node dissection are not well established.Methods The frequency and pattern of LNM from 259 PTMCs were analyzed according to the size and location of the primary tumor. Of the 259, 24 with palpable nodes underwent therapeutic node dissection and the other 235 patients without palpable nodes underwent prophylactic node dissection. The authors compared the results of node dissection between the therapeutic group and the prophylactic group, and between PTMCs 5 mm or smaller and PTMCs larger than 5 mm. The authors also compared nodal recurrence between the prophylactic group and a no-lymph-node-dissection group (155 PTMCs).Results Overall, 64.1% (166/259) and 44.5% (93/209) had node involvement of the central and ipsilateral lateral compartment, respectively. Pretracheal (43.2%), ipsilateral central (36.3%), and ipsilateral mid-lower (37.8%) jugular were more commonly involved. LNM was more frequent in the therapeutic group than in the prophylactic group (95.8% vs. 60.9% for central compartment, 83.3% vs. 39.5% for ipsilateral lateral compartment). Nodal recurrence was more common in the therapeutic group than in the prophylactic group (16.7% vs. 0.43%), but did not differ between the prophylactic group and the no-dissection group (0.43% vs. 0.65%). The tumor size did not influence nodal recurrence. Nodal recurrence preferentially occurred in ipsilateral mid-lower jugular nodes.Conclusions Patients who have PTMC presenting with palpable lymphadenopathy should have therapeutic node dissection. Prophylactic node dissection is not beneficial in those without palpable lymphadenopathy.