Roh Jong-Lyel, Kim Jin-Man, Park Chan Il
Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-dong, Songpa-gu, Seoul, 138-736, South Korea.
Ann Surg Oncol. 2008 Sep;15(9):2482-6. doi: 10.1245/s10434-008-0044-6. Epub 2008 Jul 9.
Although several factors are thought to predict the occurrence of lymph node metastases from papillary thyroid microcarcinoma (PTMC), the pattern of nodal metastasis has been rarely studied. We evaluated the pattern and factors predictive of central cervical metastasis from PTMC.
Seventy-two patients with PTMC underwent total thyroidectomy and central neck dissection, including three who underwent therapeutic modified radical neck dissection. Lymph node involvement was analyzed by neck subsite, and clinicopathologic variables predictive of nodal metastasis were determined.
Central and lateral nodal metastases were found in 29 (40.3%) and 3 (4.2%) patients, respectively, and ipsilateral paratracheal, pretracheal, superior mediastinal, and contralateral paratracheal lymph node metastases in 27 (37.5%), 8 (11.1%), 4 (5.6%), and 1 (1.4%), respectively. Sex, age, tumor size, multifocality, bilaterality, extracapsular invasion, lymphovascular invasion, and MACIS (metastases, age, completeness of resection, invasion, size) for central node metastasis were not predictive of metastasis (P > .1). Temporary and permanent hypocalcemia was observed in 17 (23.6%) and 1 (1.4%) patients, respectively, and transient vocal fold paralysis in 1 (1.4%).
Despite the absence of palpable neck nodes, PTMC is associated with a high rate of central lymph node metastasis to ipsilateral and pretracheal subsites. No clinicopathologic factor predicted nodal metastasis. In patients with PTMC involving one lobe and positive nodes, neck dissection may exclude the contralateral side.
尽管有多种因素被认为可预测甲状腺微小乳头状癌（PTMC）发生淋巴结转移，但淋巴结转移模式却鲜有研究。我们评估了PTMC中央区淋巴结转移的模式及预测因素。
72例PTMC患者接受了全甲状腺切除术及中央区颈淋巴结清扫术，其中3例接受了治疗性改良根治性颈淋巴结清扫术。按颈部亚部位分析淋巴结受累情况，并确定预测淋巴结转移的临床病理变量。
分别有29例（40.3%）和3例（4.2%）患者出现中央区和侧方淋巴结转移，同侧气管旁、气管前、上纵隔及对侧气管旁淋巴结转移分别为27例（37.5%）、8例（11.1%）、4例（5.6%）和1例（1.4%）。性别、年龄、肿瘤大小、多灶性、双侧性、包膜外侵犯、脉管侵犯以及中央区淋巴结转移的MACIS（转移、年龄、切除完整性、侵犯、大小）均不能预测转移（P>.1）。分别有17例（23.6%）和1例（1.4%）患者出现暂时性和永久性低钙血症，1例（1.4%）出现短暂性声带麻痹。
尽管颈部未触及肿大淋巴结，但PTMC发生同侧及气管前亚部位中央区淋巴结转移的几率较高。尚无临床病理因素可预测淋巴结转移。对于单侧叶受累且淋巴结阳性的PTMC患者，颈淋巴结清扫术可排除对侧。
