The Role of Node Dissection for Thyroid Cancer.
The Role of Node Dissection for Thyroid Cancer.
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淋巴结清扫在甲状腺癌中的作用。
DOI：
10.1016/j.yasu.2021.05.010
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发表时间：
2021-09
影响因子：
--
通讯作者：
Pitt SC
中科院分区：
文献类型：
--
作者：
Randle RW;Pitt SC
背景：分化良好的甲状腺癌包括最常见的甲状腺癌类型：乳头状癌、滤泡状癌和甲状腺癌。其他甲状腺癌包括源自滤泡旁 c 细胞的甲状腺髓样癌和甲状腺未分化癌。尽管区域淋巴结转移的频率因甲状腺癌的类型而异，但淋巴结受累通常很常见。虽然淋巴结清扫术对于具有微转移性疾病的低风险肿瘤的效用值得怀疑，但肉眼可见的淋巴结疾病很容易在术前识别并应予以解决。因此，在评估甲状腺结节是否存在潜在恶性肿瘤时，对颈部淋巴结进行彻底评估非常重要。同样，对这些区域淋巴结的关注是监测甲状腺癌患者复发的重要组成部分。流行病学：甲状腺癌是最常见的内分泌恶性肿瘤，近年来观察到的发病率增加并不完全归因于早期发现。 1 目前的估计表明，美国近 2% 的女性会在其一生中被诊断出来，甲状腺癌约占每年所有新诊断癌症的 3%。 2 乳头状癌是最常见的甲状腺癌类型，占甲状腺癌病例的近 90% 3，约三分之一的患者存在区域淋巴结病变。 1, 4 对于滤泡性细胞癌或 hürthle 细胞癌患者来说，淋巴结转移不太常见，因为它们倾向于血行扩散。虽然甲状腺髓样癌在甲状腺恶性肿瘤中所占的比例比分化良好的 3 型要小得多，但超过三分之一的人在诊断 5 时会出现淋巴结转移，并且由于其更具侵袭性的生物学特性，无论肿瘤大小如何，都建议进行淋巴结清扫。 6 因此，治疗甲状腺癌的临床医生应熟悉淋巴结转移的处理以及淋巴结清扫对甲状腺癌患者的作用。
Background:Well-differentiated thyroid cancer includes the most common type of thyroid cancer, papillary, as well as follicular and hürthle cell cancers. Other thyroid cancers include medullary thyroid cancer, which derives from the parafollicular c cells, and anaplastic thyroid cancer. Although the frequency of regional lymph node metastases varies depending on the type of thyroid cancer, nodal involvement is generally common. While the utility of a node dissection for low-risk tumors with micrometastatic disease is questionable, macroscopic nodal disease is easily identified pre-operatively and should be addressed. Therefore, it is important to include a thorough assessment of the cervical lymph nodes during the evaluation of thyroid nodules for potential malignancy. Similarly, attention to these regional lymph nodes is a vital part of monitoring thyroid cancer patients for recurrence.Epidemiology:Thyroid cancer is the most common endocrine malignancy, and the observed increase in incidence in recent years is not fully attributable to earlier detection. 1 Current estimates indicate that nearly 2% of women in the United States will be diagnosed during their lifetime, and thyroid cancer accounts for approximately 3% of all new cancer diagnoses each year. 2 Papillary is the most common type of thyroid cancer accounting for nearly 90% of cases 3, and regional nodal disease is present in about a third of patients. 1, 4 Nodal metastases are much less common for patients with follicular or hürthle cell cancer as these tend to spread hematogenously. Although medullary thyroid cancer accounts for a much smaller proportion of thyroid malignancies than well-differentiated types 3, over a third will have nodal metastases at diagnosis 5, and due to its more aggressive biology, lymph node dissection is recommended regardless of the tumor size. 6 Therefore, clinicians treating thyroid cancer should be familiar with the management of nodal metastases and the role of lymph node dissection for patients with thyroid cancer.