Eweida Ahmad M, Sakr Mahmoud F, Hamza Yasser, Khalil Mohamed R, Gabr Essam, Koraitim Tarek, Al-Wagih Hatem F, Abo-Elwafa Waleed, Ezzat Abdel-Aziz Tarek, Diab Ahmed A, El-Sabaa Basma, Nabawi Aman S
Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
Department of Plastic and Reconstructive Surgery, University of Heidelberg, Heidelberg, Germany.
Eur Arch Otorhinolaryngol. 2017 Apr;274(4):1951-1958. doi: 10.1007/s00405-016-4423-5. Epub 2016 Dec 20.
Most of the studies on the incidence, pattern, and predictive factors of lymph node (LN) metastasis with papillary thyroid carcinoma (PTC) have been performed retrospectively and no common consensus has been reached regarding the predictors for the involvement of level I LNs. This study was conducted prospectively to determine the incidence and the possible predictors of level I involvement in N1b PTC patients. The study included 30 consecutive patients with N1b stage of PTC. All the patients underwent neck dissection (ND) including level I. The relation between involvement of level I LNs and various clinicopathological variables was studied. Unilateral neck dissection was performed in 24 patients and bilateral neck dissection in six patients leading to 36 NDs. Level I was excised in all patients, with five specimens (14%) positive for metastasis. Levels II, III, IV, V, VI, and VII were positive in 52.8, 58.3, 58.3, 33.3, 63, and 22.2%, respectively. Level I involvement was significantly related to the number of lymph node levels affected (p = 0.003) and macroscopic extranodal invasion (p = 0.04). It was not related to the involvement of other individual levels, gender, age, size of the largest thyroid nodule, size of the largest LN involved, or histo-pathological variant of the tumor. This study suggests that including level I in therapeutic neck dissection for N1b PTC patients might be recommended in selected cases of multiple level involvement and macroscopic extranodal invasion requiring sacrifice of internal jugular vein, spinal accessory nerve, or sternomastoid muscle.
大多数关于甲状腺乳头状癌（PTC）淋巴结（LN）转移的发生率、模式及预测因素的研究都是回顾性的，对于Ⅰ区淋巴结受累的预测因素尚未达成共识。本研究前瞻性地确定N1b期PTC患者Ⅰ区受累的发生率及可能的预测因素。该研究纳入了30例连续的N1b期PTC患者。所有患者均接受了包括Ⅰ区在内的颈部清扫术（ND）。研究了Ⅰ区淋巴结受累与各种临床病理变量之间的关系。24例行单侧颈部清扫术，6例行双侧颈部清扫术，共进行了36次颈部清扫。所有患者均切除了Ⅰ区，5个标本（14%）有转移阳性。Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ和Ⅶ区转移阳性率分别为52.8%、58.3%、58.3%、33.3%、63%和22.2%。Ⅰ区受累与受累淋巴结区域数量（p = 0.003）及肉眼可见的结外侵犯（p = 0.04）显著相关。它与其他单个区域的受累、性别、年龄、最大甲状腺结节大小、最大受累淋巴结大小或肿瘤的组织病理学变异无关。本研究表明，对于N1b期PTC患者，在某些需要牺牲颈内静脉、副神经或胸锁乳突肌的多区域受累及肉眼可见结外侵犯的特定病例中，可能建议在治疗性颈部清扫中包括Ⅰ区。
