Kameyama Kaori, Takami Hiroshi
Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan.
Nihon Geka Gakkai Zasshi. 2013 Jan;114(1):34-7.
It is not uncommon for micrometastases to be detected in the regional lymph nodes in patients with thyroid cancer. It remains controversial whether lymph node dissection improves patient outcomes. According to the clinical guidelines edited by the Japan Association of Endocrine Surgeons and Japanese Society of Thyroid Surgeons, there is no evidence that prophylactic central compartment dissection improves the cause-specific survival of papillary carcinoma patients. However, it is recommended at initial surgery because reoperation for recurrence in this compartment may induce severe complications. On the other hand, prophylactic lateral node dissection can reduce the risk of recurrence to the nodes and improve disease-free survival rates, although evidence is lacking on whether it improves cause-specific survival. Surgeons should be aware that pathologically identified metastatic lymph nodes are less common than actual metastatic lesions and determine the disease entity of ectopic thyroid tissue in lymph nodes. Recently, useful new techniques such as thyroglobulin measurement of fine-needle aspiration specimens or sentinel lymph node biopsy have become established.
在甲状腺癌患者的区域淋巴结中检测到微转移并不罕见。淋巴结清扫是否能改善患者预后仍存在争议。根据日本内分泌外科学会和日本甲状腺外科学会编辑的临床指南，没有证据表明预防性中央区清扫能提高乳头状癌患者的病因特异性生存率。然而，在初次手术时建议进行清扫，因为该区域复发后的再次手术可能会引发严重并发症。另一方面，预防性侧方淋巴结清扫可以降低淋巴结复发风险并提高无病生存率，尽管缺乏其是否能提高病因特异性生存率的证据。外科医生应意识到，病理检查发现的转移性淋巴结比实际的转移病灶少见，并确定淋巴结中异位甲状腺组织的疾病实体。近年来，诸如细针穿刺标本的甲状腺球蛋白测量或前哨淋巴结活检等有用的新技术已经确立。
