Lee Se Kyung, Lee Jun Ho, Bae Soo Youn, Kim Jiyoung, Kim Minkuk, Lee Hyun-Chul, Jung Yoon Yang, Kil Won Ho, Kim Seok Won, Lee Jeong Eon, Nam Seok Jin, Choe Jun-Ho, Kim Jung-Han, Kim Jee Soo
Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Surgery. 2015 Mar;157(3):518-25. doi: 10.1016/j.surg.2014.10.013. Epub 2014 Nov 6.
Although occult metastasis to lymph node in the lateral neck compartment is common in papillary thyroid carcinoma (PTC), the clinical impact of these metastasis is unknown. We hypothesized that sentinel lymph node biopsy (SLNB) of the lateral neck compartment with radioisotopes may detect occult metastasis, which could prevent recurrence.
This randomized, controlled study was conducted from June 2009 to January 2011 and included 283 patients with PTC who were receiving treatment at the Samsung Medical Center.
Of the 283 patients enrolled in the study, 141 were randomized to a lateral SLNB (LSLNB) group and 142 patients were to the control group. Lateral sentinel lymph nodes (LSLNs) were identified in 80 of the 127 patients (63.0%) for whom stimulated thyroglobulin (sTg) levels were available. Among the 80 patients with LSLNs, 24 (30.0%) had metastases and underwent an ipsilateral modified radical neck dissection. Among the 191 patients for whom repeated sTg test results were available, the first median level of sTg in the LSLNB study group was less compared with the control group (P = .012, adjusted for duration). However, the second sTg level (after the first radioactive iodine ablation) was not different between the 2 groups. Moreover, the sTg levels were not significantly different between the LSLN-positive (n = 23) and other patients (n = 168) after the first and second ablations. During patient follow-up (median, 39 months; range, 7-55), 3 cases of recurrence were observed in the control group and 1 case in the study group (a LSLN had not been detected in this case).
Although LSLNB was able to remove occult metastasis in PTC, this procedure had no effect on either sTg levels or on recurrence rates at a mean follow-up of 39 months. Additional long-term studies are needed to explore fully the clinical usefulness of LSLNB in the prevention of PTC recurrence.
尽管甲状腺乳头状癌（PTC）患者颈部侧方区域出现隐匿性淋巴结转移很常见，但这些转移的临床影响尚不清楚。我们推测，采用放射性同位素对颈部侧方区域进行前哨淋巴结活检（SLNB）可能会检测到隐匿性转移，从而预防复发。
这项随机对照研究于2009年6月至2011年1月进行，纳入了283例在三星医疗中心接受治疗的PTC患者。
在纳入研究的283例患者中，141例被随机分配至颈部侧方前哨淋巴结活检（LSLNB）组，142例被分配至对照组。在127例可获得刺激甲状腺球蛋白（sTg）水平的患者中，有80例（63.0%）发现了颈部侧方前哨淋巴结（LSLN）。在这80例有LSLN的患者中，24例（30.0%）出现转移，并接受了同侧改良根治性颈清扫术。在191例可获得重复sTg检测结果的患者中，LSLNB研究组sTg的首个中位数水平低于对照组（P = 0.012，校正持续时间后）。然而，两组之间的第二个sTg水平（首次放射性碘消融后）并无差异。此外，首次和第二次消融后，LSLN阳性患者（n = 23）与其他患者（n = 168）的sTg水平并无显著差异。在患者随访期间（中位数为39个月；范围为7 - 55个月），对照组观察到3例复发，研究组观察到1例复发（该病例未检测到LSLN）。
尽管LSLNB能够清除PTC中的隐匿性转移，但在平均39个月的随访中，该手术对sTg水平或复发率均无影响。需要进行更多长期研究，以充分探索LSLNB在预防PTC复发方面的临床实用性。
