Yan Dan-gui, Zhang Bin, An Chang-ming, Zhang Zong-min, Li Zheng-jiang, Xu Zhen-gang, Tang Ping-zhang
Department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2011 Nov;46(11):887-91.
To study the patterns of cervical lymph nodes metastasis and the surgical managements of cervical lymph nodes in clinical N0 (cN0) papillary thyroid carcinoma.
Fifty-one consecutive patients with papillary carcinomas without clinical evidence of cervical lymph node involvement were included in the study between August 2007 and September 2010, in which 53 sides underwent neck lymph node dissection. Preoperative lymphoscintigraphy intra-operative hand-held gamma probe detecting and blue dye technique were used to detect the sentinel lymph node (SLN). SLNs were sent to frozen-section and the results were compared with specimen of routine selective neck dissection. All the pathologic specimens were reviewed by pathologists, counting the numbers of pathologic positive nodes and mapping the localization of positive nodes in level II, III, IV, V and VI respectively. The following criteria were used to study the predictive value of lateral neck compartment lymph node metastasis: age, multifocality of the tumor, extracapsular spread (ECS), tumor size, and the number of central compartment metastasis nodes. Univariate analysis with the χ2 test was used to analyze the statistical correlation between lateral neck compartment lymph node metastasis and the other clinical factors. Multiple logistic regression analysis was used to identify the multivariate correlates of lateral neck compartment metastasis.
The occult lymph node metastasis and lateral neck metastasis rates were 77.4% and 58.5% respectively, central compartment metastasis ≥3 nodes was the only independent predictive factor for the metastasis in lateral neck. Twelve sides were pN0 and other 41 sides were pN+ in all 53 side specimens. Of 41 sides with pN+, 17 sides (41.5%) involved single site and 24 sides (58.5%) involved multi-sites. The distribution of metastasis lymph nodes:level VI 62.3%, level III 52.8%, level IV 30.2%, level II 18.9%, and level V 0%.
Cervical occult lymph node metastasis in cN0 papillary thyroid carcinoma mainly localizes in level VI, level III, level IV and level II.Selective neck dissection including level VI, III, IV, II is enough for papillary carcinoma without clinical evidence of cervical lymph node involvement.
研究临床N0（cN0）期乳头状甲状腺癌颈淋巴结转移规律及颈淋巴结的手术处理方式。
选取2007年8月至2010年9月间连续收治的51例无颈淋巴结转移临床证据的乳头状癌患者，共53侧行颈淋巴结清扫术。术前采用淋巴闪烁显像、术中手持γ探测仪探测及亚甲蓝染色技术检测前哨淋巴结（SLN）。将SLN送冰冻切片检查，结果与常规选择性颈清扫标本进行比较。所有病理标本均由病理科医生复查，计数病理阳性淋巴结数量，并分别绘制II、III、IV、V和VI区阳性淋巴结的定位图。采用以下标准研究侧颈区淋巴结转移的预测价值：年龄、肿瘤多灶性、包膜外侵犯（ECS）、肿瘤大小及中央区转移淋巴结数量。采用χ2检验进行单因素分析，分析侧颈区淋巴结转移与其他临床因素之间的统计学相关性。采用多因素logistic回归分析确定侧颈区转移的多因素相关性。
隐匿性淋巴结转移率和侧颈区转移率分别为77.4%和58.5%，中央区转移≥3枚淋巴结是侧颈区转移的唯一独立预测因素。53侧标本中，12侧为pN0，41侧为pN+。41侧pN+中，17侧（41.5%）为单部位转移，24侧（58.5%）为多部位转移。转移淋巴结分布情况：VI区62.3%，III区52.8%，IV区30.2%，II区18.9%，V区0%。
cN0期乳头状甲状腺癌颈隐匿性淋巴结转移主要位于VI区、III区、IV区和II区。对于无颈淋巴结转移临床证据的乳头状癌，行包括VI、III、IV、II区的选择性颈清扫术即可。
