Koo Bon Seok, Yoon Yeo-Hoon, Kim Jin-Man, Choi Eun Chang, Lim Young Chang
Department of Otolaryngology, Head and Neck Surgery, Cancer Research Institute, Research Institute for Medical Sciences, Chungnam National University College of Medicine, Daejeon, Korea.
Ann Surg Oncol. 2009 May;16(5):1344-7. doi: 10.1245/s10434-009-0367-y. Epub 2009 Feb 18.
The extent of neck dissection (ND) appropriate for necks yielding clinical evidence of metastases of papillary thyroid carcinoma (PTC) is controversial. The need for level IIb lymph node (LN) dissection is particularly uncertain in view of its association with postoperative shoulder dysfunction. In the present study, we examined the frequency, pattern, and predictive factors of level IIb LN metastases in PTC patients with clinically positive lateral neck nodes.
We reviewed the medical records of 76 PTC patients who underwent therapeutic lateral ND for the treatment of clinically positive lateral neck nodes between March 2005 and July 2008. ND specimens were separately obtained for analyzing LN involvement with respect to neck level.
Metastatic disease at levels II, III, IV, and V, was seen in 40 (52.6%), 55 (72.4%), 52 (68.4%), and 12 (15.8%) of the patients, respectively. The metastasis rate in level IIb was 11.8% (9 of 76). By univariate analysis, the rate of level IIb LN metastasis was significantly higher in patients with positive level IIa LNs and positive LNs in all lateral neck levels (levels IIa + III + IV) (P < .05). Multivariate analysis showed that positive LN involvement in all lateral neck levels (IIa + III + IV) was an independent predictive factor of level IIb LN metastasis (P = .044, odds ratio = 9.692).
Level IIb LN dissection may be omitted in the treatment of positive neck nodes in PTC patients if multilevel involvement including level IIa involvement is absent.
对于出现甲状腺乳头状癌（PTC）转移临床证据的颈部，合适的颈清扫范围存在争议。鉴于Ⅱb区淋巴结清扫与术后肩部功能障碍相关，Ⅱb区淋巴结清扫的必要性尤其不确定。在本研究中，我们调查了临床颈部侧方淋巴结阳性的PTC患者Ⅱb区淋巴结转移的频率、模式及预测因素。
我们回顾了2005年3月至2008年7月期间76例因临床颈部侧方淋巴结阳性而接受治疗性侧方颈清扫的PTC患者的病历。分别获取颈清扫标本以分析各颈部区域的淋巴结受累情况。
Ⅱ、Ⅲ、Ⅳ和Ⅴ区出现转移性疾病的患者分别为40例（52.6%）、55例（72.4%）、52例（68.4%）和12例（15.8%）。Ⅱb区转移率为11.8%（76例中的9例）。单因素分析显示，Ⅱa区淋巴结阳性以及所有颈部侧方区域（Ⅱa + Ⅲ + Ⅳ区）淋巴结阳性的患者，Ⅱb区淋巴结转移率显著更高（P < 0.05）。多因素分析表明，所有颈部侧方区域（Ⅱa + Ⅲ + Ⅳ区）淋巴结阳性是Ⅱb区淋巴结转移的独立预测因素（P = 0.044，比值比 = 9.692）。
如果不存在包括Ⅱa区受累在内的多区域受累情况，PTC患者颈部淋巴结阳性的治疗中可省略Ⅱb区淋巴结清扫。
