Salter Kelli D, Andersen Peter E, Cohen James I, Schuff Kathyrn G, Lester Linda, Shindo Maisie L, Sauer David, Gross Neil D
Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA.
Arch Otolaryngol Head Neck Surg. 2010 Jul;136(7):692-6. doi: 10.1001/archoto.2010.112.
To determine the risk of nodal metastases to the central compartment from differentiated papillary thyroid carcinoma (PTC) relative to known prognostic variables.
A 7-year single-institutional retrospective review.
Tertiary academic center.
A total of 115 patients undergoing central neck dissection (CND) for PTC or follicular variant PTC (FVPTC).
Number, location, and positivity of lymph nodes for malignant disease in the central compartment based on patient age, sex, extrathyroidal extension, and primary tumor size, histologic type, and focality.
Eighty-seven percent of patients had PTC, and 13% had FVPTC. Bilateral (64%) or ipsilateral (36%) CND was performed in patients with PTC. Patients with FVPTC underwent only ipsilateral CND. There was no significant difference in the number of lymph nodes retrieved based on patient age or sex, histologic type of the primary tumor, size or focality, or surgeon or pathologist. Seventy-eight percent of patients with PTC had malignant lymph nodes in the ipsilateral (75%) or bilateral/contralateral (69%) central compartment. Ipsilateral nodal metastases directly correlated with tumor multifocality (r = 0.93; P = .001) and size (r = 0.89; P = .001). Bilateral nodal metastases directly correlated with tumor multifocality (r = 0.92; P = .001) but was independent of size (r = 0.56; P = .001). No malignant lymph nodes were identified in the central compartment of FVPTC.
Malignant central nodal metastases occur with high frequency in PTC but not in FVPTC. The risk of metastases correlated with the size and multifocality of the primary tumor. Additional studies are warranted to determine the extent of CND in patients with and without known multifocal disease and to determine the role of CND in patients with FVPTC.
确定分化型甲状腺乳头状癌（PTC）相对于已知预后变量发生中央区淋巴结转移的风险。
一项为期7年的单机构回顾性研究。
三级学术中心。
总共115例因PTC或滤泡状变异型PTC（FVPTC）接受中央区颈清扫术（CND）的患者。
根据患者年龄、性别、甲状腺外侵犯、原发肿瘤大小、组织学类型和灶性，观察中央区恶性疾病淋巴结的数量、位置和阳性情况。
87%的患者患有PTC，13%患有FVPTC。PTC患者进行双侧（64%）或同侧（36%）CND。FVPTC患者仅接受同侧CND。根据患者年龄或性别、原发肿瘤的组织学类型、大小或灶性、外科医生或病理学家，所获取淋巴结的数量无显著差异。78%的PTC患者同侧（75%）或双侧/对侧（69%）中央区有恶性淋巴结。同侧淋巴结转移与肿瘤多灶性直接相关（r = 0.93；P = 0.001）和大小（r = 0.89；P = 0.001）。双侧淋巴结转移与肿瘤多灶性直接相关（r = 0.92；P = 0.001），但与大小无关（r = 0.56；P = 0.001）。FVPTC中央区未发现恶性淋巴结。
PTC中恶性中央区淋巴结转移发生率高，而FVPTC中则不然。转移风险与原发肿瘤的大小和多灶性相关。有必要进行进一步研究以确定已知有多灶性疾病和无多灶性疾病患者的CND范围，并确定CND在FVPTC患者中的作用。
