Section of Clinica Chirurgica, Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, S. Anna University Hospital, Ferrara, Italy.
Section of Clinica Chirurgica, Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, S. Anna University Hospital, Ferrara, Italy.
Surgery. 2014 Jul;156(1):147-57. doi: 10.1016/j.surg.2014.03.045.
Prospective uncontrolled study to investigate in papillary thyroid carcinoma (PTC) patients: (1) Distribution of lymph node metastases within the neck compartments, (2) factors predicting lymph nodes metastases, and (3) disease recurrence after thyroidectomy associated with radio-guided selective compartment neck dissection (RSCND).
We studied 345 consecutive PTC patients operated on between February 2004 and October 2011 at the S. Anna University Hospital, Ferrara (Italy). Patients with cervical lymph node metastases on preoperative ultrasonography and fine needle aspiration cytology were excluded. All patients underwent total thyroidectomy associated with SLN identification followed by RSCND in the SLN compartment, without SLN frozen section.
In patients with lymph node metastases, metastatic nodes were not in the central neck compartment in 22.6% of the cases. The presence of infiltrating or multifocal PTC was a predicting factor for lymph nodes metastases. The median follow-up was 35.5 months. RSCND was associated with a false-negative rate of 1.1%, a persistent disease rate of 0.6%, and a recurrent disease rate of 0.9%. The permanent dysphonia rate was 1.3%.
RSCND associated with total thyroidectomy may improve: (1) the locoregional lymph node staging, and (2) the identification of the site of lymphatic drainage within the neck compartments. Thus, considering the high false-negative rate of sentinel lymph node biopsy (SLNB), a radio-guided technique in PTC patients may guide the lymphadenectomy (ie, RSCND) to increase the metastatic yield and improve staging of the disease rather than avoid prophylactic lymphadenectomy (ie, SLNB).
本前瞻性非对照研究旨在调查甲状腺乳头状癌（PTC）患者：（1）颈部淋巴结转移在颈部各区域的分布，（2）预测淋巴结转移的因素，以及（3）与放射性引导选择性区域颈部淋巴结清扫术（RSCND）相关的甲状腺切除术后疾病复发。
我们研究了 2004 年 2 月至 2011 年 10 月在意大利费拉拉的 S. Anna 大学医院接受手术的 345 例连续 PTC 患者。排除了术前超声和细针穿刺细胞学检查发现颈部淋巴结转移的患者。所有患者均接受全甲状腺切除术，同时识别 SLN，并随后在 SLN 区域进行 RSCND，无需进行 SLN 冷冻切片检查。
在有淋巴结转移的患者中，转移淋巴结不在中央颈部区域的比例为 22.6%。浸润性或多灶性 PTC 的存在是淋巴结转移的预测因素。中位随访时间为 35.5 个月。RSCND 的假阴性率为 1.1%，持续性疾病率为 0.6%，复发性疾病率为 0.9%。永久性声音嘶哑的发生率为 1.3%。
与全甲状腺切除术联合的 RSCND 可能改善：（1）局部区域淋巴结分期，（2）颈部区域内淋巴结引流部位的识别。因此，考虑到前哨淋巴结活检（SLNB）的高假阴性率，放射性引导技术可能有助于指导甲状腺癌患者的淋巴结切除术（即 RSCND），以提高转移率并改善疾病分期，而不是避免预防性淋巴结切除术（即 SLNB）。
