Lee Yoon Se, Lee Byung-Joo, Hong Hyun Joon, Lee Kang-Dae
Department of Otorhinolaryngology-Head and Neck Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Hospital, Busan Department of Otolaryngology, Catholic Kwandong University International St. Mary's Hospital, Incheon Department of Otolaryngology, Kosin University Gospel Hospital, Busan, Korea.
Medicine (Baltimore). 2017 Nov;96(45):e8596. doi: 10.1097/MD.0000000000008596.
Although several thyroid associations have published various guidelines, controversies especially in cases of micropapillary thyroid cancer (MPTC) still exist. This survey was designed to collect information about diagnostic tests and treatments performed on patients with MPTC and help identify current trends in thyroid surgery.We developed questionnaires about the management methods for MPTC, which were used to identify factors related to indications of fine needle aspiration (FNA), type of surgery, and central lymph node dissection (CLND). Active 60 members of the Korean Society of Thyroid-Head and Neck Surgery participated in the study in September 2016.Ultrasound-guided FNA was usually initiated when the tumor was at least 5 mm (60%). All respondents preferred ultrasound-guided FNA and surgery for nodules with extrathyroidal extension (ETE). The preferred treatment option for intraglandular MPTC was lobectomy (92%) rather than active surveillance (8%). Posterolateral ETE increased the respondents' preference for total thyroidectomy (61.7%). Active surveillance was preferred for tumors <5 mm, which was decreased by the presence of ETE. The presence of ETE (73.3%) and its proximity to critical organs (46.7%) were the main determining factors for prophylactic CLND. For multiple metastatic lymph nodes at level III, selective neck dissection including levels IIb (23.3%) and V (78.3%) was preferred in addition to levels IIa, III, VI, and V.Korean head and neck surgeons favored total thyroidectomy and CLND in cases wherein ETE, central lymph node metastasis, or critical organ involvement was suspected.
尽管多个甲状腺协会已发布了各种指南，但争议仍然存在，尤其是在微小乳头状甲状腺癌（MPTC）病例中。本调查旨在收集有关MPTC患者诊断检查和治疗的信息，并有助于确定甲状腺手术的当前趋势。我们编制了关于MPTC管理方法的问卷，用于确定与细针穿刺活检（FNA）指征、手术类型和中央淋巴结清扫（CLND）相关的因素。韩国甲状腺头颈外科学会的60名活跃成员于2016年9月参与了该研究。当肿瘤至少5毫米时，通常会开始超声引导下的FNA（60%）。所有受访者都倾向于对有甲状腺外侵犯（ETE）的结节进行超声引导下的FNA和手术。腺内MPTC的首选治疗方案是甲状腺叶切除术（92%）而非主动监测（8%）。后外侧ETE增加了受访者对全甲状腺切除术的偏好（61.7%）。对于<5毫米的肿瘤，主动监测是首选，而ETE的存在会降低这种偏好。ETE的存在（73.3%）及其与关键器官的接近程度（46.7%）是预防性CLND的主要决定因素。对于III区多个转移性淋巴结，除IIa、III、VI和V区外，还倾向于进行包括IIb区（23.3%）和V区（78.3%）的选择性颈清扫术。韩国头颈外科医生在怀疑有ETE、中央淋巴结转移或关键器官受累的情况下，倾向于进行全甲状腺切除术和CLND。
