Lateral Lymph Node Metastasis in Papillary Thyroid Carcinoma: Results of Therapeutic Lymph Node Dissection
Lateral Lymph Node Metastasis in Papillary Thyroid Carcinoma: Results of Therapeutic Lymph Node Dissection
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DOI：
10.1089/thy.2008.0244
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发表时间：
2009-03-01
期刊：
影响因子：
6.6
通讯作者：
Park, Woo-Chan
中科院分区：
文献类型：
--
作者：
Chung, Yoo Seung;Kim, Jee Young;Park, Woo-Chan
背景：颈部淋巴结转移在乳头状甲状腺癌（PTC）中非常常见，并且通常以连续的方式扩散。然而，“跳跃转移”，定义为没有中央淋巴结转移的外侧淋巴结转移，也发生在PTC患者中。关于甲状腺微小乳头状癌跳跃性转移的资料很少。本研究的目的是确定跳跃转移PTMC.Methods的患病率和相关的临床和影像学特征：我们进行了一项回顾性研究，245例PTMC谁接受甲状腺切除术和中央淋巴结清扫术或甲状腺切除术，中央淋巴结清扫术，外侧淋巴结清扫术，如果术前超声检查或计算机断层扫描提示外侧淋巴结转移。结果：26.5%的病例有颈淋巴结转移，其中11.5%的病例有颈淋巴结转移。单纯甲状腺切除+中央淋巴结清扫组淋巴结转移率为21.8%，甲状腺切除+中央淋巴结清扫+侧方淋巴结清扫组淋巴结转移率为51.3%。年龄小、肿瘤体积大、多样性、双侧性、包膜、甲状腺外侵犯和淋巴管浸润与中央或外侧室淋巴结转移有关。15.9%的患者进行了外侧淋巴结清扫。在行中央和外侧淋巴结清扫的病例中，7.7%观察到跳跃转移。没有功能的原发性甲状腺肿瘤可能与跳跃式transferation.Conclusions的发展：跳跃式转移发生在少数PTMC患者。因此，我们建议对怀疑患有PTMC的患者进行术前检查，不仅要关注中央室淋巴结，还要关注颈外侧淋巴结，因为所获得的信息将指导手术范围。
Background: Cervical lymph node metastases are quite common in papillary thyroid cancer (PTC) and they usually spread in a contiguous fashion. However, "skip metastasis,'' defined as lateral lymph node metastasis without central lymph node metastasis, also occurs in patients with PTC. There is little information regarding skip metastasis in papillary thyroid microcarcinoma (PTMC). The goal of this study was to determine the prevalence and associated clinical and imaging features of skip metastasis in PTMC.Methods: We performed a retrospective study of 245 patients with PTMC who underwent either thyroidectomy and central lymph node dissection or thyroidectomy, central lymph node dissection, and lateral lymph node dissection if preoperative ultrasonography or computed tomography suggested lateral node metastasis. Clinicopathologic results were reviewed, and the patterns of cervical lymph node metastasis were analyzed.Results: Cervical lymph node metastases were present in 26.5% of cases. The frequency of lymph node metastases was 21.8% in the group that only had thyroidectomy and central lymph node dissection and 51.3% in the group that had thyroidectomy, central lymph node dissection, and lateral lymph node dissection. Younger age, larger tumor size, multiplicity, bilaterality, encapsulation, extrathyroid extension, and lymphatic invasion were associated with metastasis to nodes in the central or lateral compartment. Lateral lymph node dissection was performed in 15.9% of patients. Skip metastasis was observed in 7.7% of the cases in which combined central and lateral node dissection was performed. No features of the primary thyroid tumor could be associated with the development of skip metastasis.Conclusions: Skip metastases occur in a minority of patients with PTMC. We recommend, therefore, that preoperative studies in patients suspected of having PTMC focus not only on nodes in the central compartment but also lateral cervical nodes since the information obtained would guide the extent of surgery.