Wan Hanfeng, Zhang Bin, Liu Shaoyan, Li Zhengjiang, Wu Yuehuang, Wang Xiaolei, Xu Zhengang, Tang Pingzhang
Department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
Department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China. Email:
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2014 Jan;49(1):27-30.
To evaluate the factors related to level IIb lymph node(LN) metastasis in papillary thyroid carcinoma (PTC). Method The medical records of 63 PTC patients were reviewed. The patients underwent neck dissection (ND) between January 2011 and December 2012, who were determined with pathologically lateral cervical LN metastasis. A total of 67 ND specimens were obtained and analyzed for LN involvement with respect to neck levels. The relation of level IIb LN metastasis with clinical factors, including age and sex of patients, tumor size, location, multifocality, extracapsular spread (ECS) and stage of primary PTC, coexistence of lymphocytic thyroiditis, distribution of metastasis LN in different levels, fusion and extracapsular invasion of LN were analyzed with univariate analysis and χ(2) test. SPSS 14.0 software was used to analyze the data.
Of 63 patients, 41 patients revealed thyroid tumor maximum diameter more than 1 centimeter, 26 patients with tumor located in the upper 1/3 thyroid lobe, 39 patients with multiplicity of thyroid tumor and 54 patients with ECS, 54 patients with pathological T3/T4a stage, 15 patients with coexisting lymphocytic thyroiditis. Among the 67 ND specimens, 12 specimens (17.9%) showed level IIb LN metastasis and the incidences of LN metastasis at level IIa, III, IV, V, VI, IIa+III, III+IV, and IIa+III+IV were 56.7%, 86.6%, 68.7%, 22.4%, 86.6%, 52.2%, 55.2%, 37.3%, respectively. Of the 38 ND specimens with level IIa LN metastases, 10 were positive in level IIb(26.3%). But of 29 ND specimens without level IIa LN metastases, only 2 were positive in level IIb. A univariate analysis revealed that level IIa LN metastasis was a significant predictive factor for level IIb LN metastasis (χ(2) = 4.219, P = 0.040).
The incidence of LN metastasis to level IIb is low in PTC, which is less when level IIa is not involved.
评估与甲状腺乳头状癌（PTC）Ⅱb区淋巴结转移相关的因素。方法回顾63例PTC患者的病历。这些患者于2011年1月至2012年12月期间接受了颈部淋巴结清扫术（ND），术后经病理检查确定为侧颈部淋巴结转移。共获取67份ND标本，分析颈部各区域淋巴结受累情况。采用单因素分析和χ²检验分析Ⅱb区淋巴结转移与临床因素的关系，临床因素包括患者的年龄、性别、肿瘤大小、位置、多灶性、包膜外侵犯（ECS）、原发性PTC的分期、淋巴细胞性甲状腺炎的并存情况、不同区域转移淋巴结的分布、淋巴结融合及包膜外侵犯情况。使用SPSS 14.0软件进行数据分析。
63例患者中，41例患者甲状腺肿瘤最大直径超过1厘米，26例患者肿瘤位于甲状腺上1/3叶，39例患者甲状腺肿瘤为多灶性，54例患者存在ECS，54例患者病理分期为T3/T4a期，15例患者并存淋巴细胞性甲状腺炎。在67份ND标本中，12份标本（17.9%）显示Ⅱb区淋巴结转移，Ⅱa、Ⅲ、Ⅳ、Ⅴ、Ⅵ、Ⅱa + Ⅲ、Ⅲ + Ⅳ、Ⅱa + Ⅲ + Ⅳ区淋巴结转移发生率分别为56.7%、86.6%、68.7%、22.4%、86.6%、52.2%、55.2%、37.3%。在38份有Ⅱa区淋巴结转移的ND标本中，10份Ⅱb区为阳性（26.3%）。但在29份无Ⅱa区淋巴结转移的ND标本中，只有2份Ⅱb区为阳性。单因素分析显示，Ⅱa区淋巴结转移是Ⅱb区淋巴结转移的重要预测因素（χ² = 4.219，P = 0.040）。
PTC患者Ⅱb区淋巴结转移发生率较低，当Ⅱa区未受累时发生率更低。
