West China School of Medicine, Sichuan University, Sichuan, China.
Department of General Surgery, Zhang jia-gang First People's Hospital, Jiangsu, China.
J Endocrinol Invest. 2019 Feb;42(2):227-236. doi: 10.1007/s40618-018-0908-y. Epub 2018 Jun 6.
Lymph node metastasis (LNM) is a vital prognosis factor in patients with papillary thyroid microcarcinoma (PTMC). The study tried to identify clinicopathological factors for LNM of PTMC.
The clinicopathological data of 1031 patients with PTMC were extracted and analyzed. Univariate and multivariate analyses were used to identify risk factors associated with cervical lymph node metastasis. ROC analysis was used to determine the ideal critical points of the sum of the maximum diameter of multifocal in a unilateral lobe.
The probability of LNM, central lymph node metastasis (CLNM) and lateral lymph node metastasis(LLNM)of PTMC patients were 35.6, 33.7 and 5.6%, respectively. In addition, 1.9% PTMC had LLNM only. Male, age ≤ 40 years, tumor largest diameter ≥ 5 mm, multifocal, non-uniform echoic distribution, the sum of the maximum diameter of multifocal in a unilateral lobe ≥ 8.5 mm, tumors in the lower pole location were prone to CLNM. Ultrasound mix-echo, the sum of the maximum diameter of the multifocal ≥ 10.75 mm, tumors in the upper pole location were extremely prone to LLNM. T3 were prone to LLNM or skip LLNM.
According to the clinicopathological characteristics of PTMC, the cervical lymph nodes should be correctly evaluated to guide the surgical treatment.
淋巴结转移（LNM）是甲状腺微小乳头状癌（PTMC）患者的一个重要预后因素。本研究旨在确定影响 PTMC 淋巴结转移的临床病理因素。
提取并分析了 1031 例 PTMC 患者的临床病理资料。采用单因素和多因素分析确定与颈淋巴结转移相关的危险因素。ROC 分析用于确定单侧叶多灶性最大直径总和的理想临界值。
PTMC 患者 LNM、中央淋巴结转移（CLNM）和侧方淋巴结转移（LLNM）的概率分别为 35.6%、33.7%和 5.6%。此外，1.9%的 PTMC 仅发生 LLNM。男性、年龄≤40 岁、肿瘤最大直径≥5mm、多灶性、不均匀回声分布、单侧叶多灶性最大直径总和≥8.5mm、肿瘤位于下极位置，易发生 CLNM。超声混合回声、多灶性最大直径总和≥10.75mm、肿瘤位于上极位置，易发生 LLNM。T3 期肿瘤易发生 LLNM 或跳跃性 LLNM。
根据 PTMC 的临床病理特征，应正确评估颈部淋巴结，以指导手术治疗。
