Department of Endocrine Surgery, King's College Hospital, Denmark Hill, London, UK.
Clin Endocrinol (Oxf). 2012 Jan;76(1):131-6. doi: 10.1111/j.1365-2265.2011.04162.x.
Papillary thyroid cancer (PTC) is a common endocrine cancer and commonly presents with lymph node (LN) metastases. The role of surgical removal of the central cervical LN compartment is poorly defined. There are no prospective randomized controlled trials addressing the relevance to the extent of the initial surgical approach.
A systematic review of studies of patients with PTC undergoing either prophylactic or therapeutic lymphadenectomy of the central LNs was carried out. Studies involving imaging modalities in the detection of LNs in PTC were also analysed.
Twenty-one studies contained data on 4188 patients undergoing prophylactic or imaging-guided removal of the central compartment. Imaging-guided surgery retrieved cancerous central LNs in 346 or 30% of eligible patients, whilst prophylactic central neck dissection yielded histopathological proof of cancer in 898 or 26·2% of patients. Five imaging studies revealed data on the use of ultrasound (US) and/or computerized tomography (CT). The sensitivity of US and CT was poor, ranging from 50% to 70% when accurately calculated.
Metastatic central LNs are found in nearly half of all patients with PTC when prophylactic central lymph node dissection (CLND) is performed. With unreliable imaging modalities, prophylactic CLND should be performed on all patients with PTC.
甲状腺乳头状癌（PTC）是一种常见的内分泌癌症，常伴有淋巴结（LN）转移。中央颈淋巴结清扫术在该疾病中的作用尚未明确。目前尚无前瞻性随机对照试验探讨初始手术方式的范围与该作用的相关性。
对行预防性或治疗性中央颈部淋巴结清扫术的 PTC 患者的研究进行了系统性回顾。还分析了涉及 PTC 中淋巴结检测的影像学方法的研究。
21 项研究共纳入了 4188 例接受预防性或影像学引导下中央区清扫术的患者的数据。影像学引导手术在 346 例（30%）符合条件的患者中发现了癌性中央淋巴结，而预防性中央颈淋巴结清扫术在 898 例（26.2%）患者中证实存在癌组织。5 项影像学研究报告了超声（US）和/或计算机断层扫描（CT）的使用数据。当准确计算时，US 和 CT 的灵敏度较差，范围为 50%至 70%。
当行预防性中央颈淋巴结清扫术（CLND）时，几乎所有 PTC 患者中都有近一半存在中央淋巴结转移。由于影像学方法不可靠，所有 PTC 患者均应行预防性 CLND。
