Department of Otorhinolaryngology-Head & Neck Surgery, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea.
Surgery. 2010 Feb;147(2):241-5. doi: 10.1016/j.surg.2009.09.002. Epub 2009 Nov 11.
The extent of lateral neck dissection for clinically evident nodal metastases in the lateral neck in a patient with papillary thyroid cancer (PTC) continues to remain controversial.
We reviewed retrospectively the medical records between March 2005 and March 2008 of 70 patients with PTC who underwent therapeutic lateral neck dissections (level II-V) to establish indications for omission of a level V lymphadenectomy. No patient in the study had a clinically positive level V lymph node. Neck dissection specimens were obtained for histologic analysis for node metastasis with respect to the individual neck levels.
Thirty-four (49%), 52 (74%), and 48 (69%) patients had histologically positive lymph nodes in levels II, III, and IV, respectively. Occult metastases in level V were observed in 11 (16%) patients. Isolated positive level V lymph nodes were never found, while all patients with positive level V lymph nodes had simultaneous positive level IV lymph nodes. In addition, there was no instance of a pathologically positive lymph node in level V without a suspicious metastatic lymph node in level IV by preoperative ultrasonography. In multivariate analysis, simultaneous multilevel involvement (level II, III, and IV) of lymphatic metastases was associated with level V metastasis.
Level V lymphadenectomy may be omitted in the treatment of PTC patients if positive nodes are not found on histologic exam (frozen section analysis) or by ultrasonography in level IV.
在患有甲状腺乳头状癌（PTC）的患者中，对于侧颈部临床明显的淋巴结转移，行侧颈部淋巴结清扫术的范围仍然存在争议。
我们回顾性分析了 2005 年 3 月至 2008 年 3 月期间 70 例行治疗性侧颈部清扫术（II-V 级）的 PTC 患者的病历，以确定省略 V 级淋巴结清扫术的适应证。研究中无患者有临床阳性 V 级淋巴结。对颈部淋巴结转移的各部位进行组织学分析，以获得颈部各水平的淋巴结转移情况。
分别有 34 例（49%）、52 例（74%）和 48 例（69%）患者在 II、III 和 IV 级水平上有组织学阳性淋巴结。11 例（16%）患者的 V 级存在隐匿性转移。从未发现孤立的阳性 V 级淋巴结，而所有 V 级淋巴结阳性的患者均有同时存在的 IV 级阳性淋巴结。此外，术前超声检查未发现 IV 级有可疑转移性淋巴结的情况下，V 级淋巴结无病理阳性。多因素分析显示，同时存在多个水平的淋巴结转移（II、III 和 IV 级）与 V 级转移相关。
如果在组织学检查（冷冻切片分析）或超声检查中 IV 级未发现阳性淋巴结，则可省略 PTC 患者的 V 级淋巴结清扫术。
