Ipsilateral Versus Bilateral Central Neck Lymph Node Dissection in Papillary Thyroid Carcinoma
Ipsilateral Versus Bilateral Central Neck Lymph Node Dissection in Papillary Thyroid Carcinoma
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DOI：
10.1097/sla.0b013e3181b3adab
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发表时间：
2009-09-01
影响因子：
9
通讯作者：
Fahey, Thomas J., III
中科院分区：
文献类型：
--
作者：
Moo, Tracy-Ann S.;Umunna, Ben;Fahey, Thomas J., III
目的：许多接受甲状腺乳头状癌（PTC）手术的患者在手术时都有亚临床淋巴结病变。预防性双侧中央颈部清扫术（CND）在治疗PTC a中越来越被接受，研究表明淋巴结疾病增加局部复发率，并可能改变术后放射性碘的剂量。考虑到双侧CND的潜在并发症，我们进行了一项前瞻性研究，以确定预防性同侧CND对PTC的充分性。方法：116例PTC患者在三级转诊中心行甲状腺全切除术和常规预防性CND。其中45例分别有右侧和左侧中央颈部淋巴结盆行病理检查。我们根据特纳的位置和大小检查阳性淋巴结的侧边性。结果：总体而言，45%的患者发现淋巴结阳性。在侧化的CND患者中，33%的患者只有同侧阳性淋巴结，而20%的患者有双侧阳性淋巴结。肿瘤大小为1 cm的患者无一例（P = 0.02）。多灶性不影响肿瘤的淋巴结转移
Objective: Many patients undergoing thyroidectomy for papillary thyroid carcinoma (PTC) have subclinical nodal disease at the time of surgery. Prophylactic bilateral central neck dissection (CND) is gaining acceptance in the treatment of PTC a, studies have shown nodal disease increases the rate of local recurrence and may alter postsurgical radioactive iodine dosing. Given the potential complications of bilateral CND, we undertook a prospective study to determine the adequacy of prophylactic ipsilateral CND for PTC.Methods: A total of 116 patients with PTC underwent total thyroidectomy and routine prophylactic CND at a tertiary referral center. Of these, 45 had right and left central neck lymph node basins submitted separately for pathologic examination. We examined the laterality of positive lymph nodes based on turner location and size.Results: Overall, positive lymph nodes were found in 45% of patients. Of the patients having a lateralized CND, 33% had ipsilateral positive nodes only, while 20% had bilateral positive nodes. None of the patients with tumor size 1 cm (P = 0.02). Multifocality did not affect lymph node metastasis in tumors