Machens Andreas, Hauptmann Steffen, Dralle Henning
Department of General, Visceral, and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany.
Surgery. 2009 Feb;145(2):176-81. doi: 10.1016/j.surg.2008.09.003. Epub 2008 Nov 29.
In papillary thyroid cancer, quantitative relationships may exist between central and lateral neck lymph node metastases, which may be of clinical usefulness.
This comparative analysis of central and lateral neck lymph node metastases was undertaken in 88 patients with untreated papillary thyroid cancer who underwent compartment-oriented lymph node dissection in the central and ipsilateral lateral neck. In 32 of these patients, the contralateral lateral neck was dissected in addition.
Central lymph node metastases were categorized in increments of 0 (22 patients), 1-5 (29 patients), 6-10 (12 patients), and more than 10 positive nodes (25 patients). With more than 5 positive nodes, the rates and numbers of lateral lymph node metastases increased from between 45% and 69% to 100% and from a mean of between 2 and 3 to between 6 and 8 lymph node metastases (all P < .001) in the ipsilateral neck; and from between 0% and 33% to between 60% and 71% (P = .009) and from a mean of between 0 and 1 to between 3 and 7 lymph node metastases (P = .003) in the contralateral neck. Lateral lymph node metastases in the contralateral neck always coexisted with metastases in both the central and the opposite lateral neck. When only patients with positive lateral nodes were considered, the successive increase in the number of lateral lymph node metastases was still present. Altogether, the ipsilateral neck harbored more often lateral lymph node metastasis with more positive lateral nodes than the contralateral neck.
These histopathologic associations may provide a foundation for more evidence-based decisions regarding lymph node dissection of the lateral neck compartments in patients with node-positive papillary thyroid cancer.
在乳头状甲状腺癌中，中央区和侧颈部淋巴结转移之间可能存在定量关系，这可能具有临床应用价值。
对88例未经治疗的乳头状甲状腺癌患者进行中央区和同侧侧颈部淋巴结分区清扫，并对中央区和侧颈部淋巴结转移情况进行比较分析。其中32例患者还进行了对侧侧颈部清扫。
中央区淋巴结转移情况分为0枚（22例患者）、1 - 5枚（29例患者）、6 - 10枚（12例患者）和超过10枚阳性淋巴结（25例患者）。当中央区阳性淋巴结超过5枚时，同侧颈部侧颈部淋巴结转移率从45%至69%增至100%，转移淋巴结数量从平均2至3枚增至6至8枚（所有P <.001）；对侧颈部侧颈部淋巴结转移率从0%至33%增至60%至71%（P =.009），转移淋巴结数量从平均0至1枚增至3至7枚（P =.003）。对侧颈部侧颈部淋巴结转移总是与中央区和对侧侧颈部转移同时存在。仅考虑侧颈部阳性淋巴结患者时，侧颈部淋巴结转移数量仍呈连续增加。总体而言，同侧颈部比双侧颈部更易出现侧颈部淋巴结转移且阳性侧颈部淋巴结更多。
这些组织病理学关联可为乳头状甲状腺癌淋巴结阳性患者侧颈部淋巴结清扫的更循证决策提供依据。
