Kwon Hyun-Keun, Cheon Yong-Il, Shin Sung-Chan, Sung Eui-Suk, Lee Jin-Choon, Kim In Ju, Lee Byung-Joo
Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Pusan National University and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, College of Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Gland Surg. 2021 Feb;10(2):512-520. doi: 10.21037/gs-20-368.
Metastatic lymph nodes are occasionally found in suprasternal lymph nodes in patients with papillary thyroid cancer (PTC). However, limited studies have examined these lymph nodes thus far. Therefore, we investigated the frequency and risk factors of suprasternal lymph node metastasis in patients with PTC and lateral cervical lymph node metastasis.
A total of 85 patients with cN1b PTC underwent total thyroidectomy, central neck dissection, and ipsilateral selective neck dissection including suprasternal lymph node dissection. We analyzed the correlation between suprasternal lymph node metastasis and sex, age, tumor characteristics, and cervical lymph node metastasis status.
Eleven (12.9%) patients had pathological suprasternal lymph node metastasis. Suprasternal lymph node metastasis was associated with tumors located in the inferior pole of the thyroid gland and level IV lymph node metastasis (P=0.005 and 0.014, respectively). Receiver operating characteristic curve analysis indicated that two or more level IV metastatic lymph nodes had the best predictive value for suprasternal lymph node metastasis (P<0.001).
In patients with cN1b PTC, especially those with tumors in the inferior pole of the thyroid gland or level IV lymph node metastasis, greater attention should be paid to the suprasternal lymph nodes and suprasternal lymph node dissection should be routinely included as part of selective neck dissection.
在乳头状甲状腺癌（PTC）患者中，偶尔会在胸骨上淋巴结发现转移淋巴结。然而，迄今为止，对这些淋巴结的研究有限。因此，我们调查了PTC合并侧颈淋巴结转移患者胸骨上淋巴结转移的频率及危险因素。
总共85例cN1b期PTC患者接受了全甲状腺切除术、中央区颈淋巴结清扫术以及包括胸骨上淋巴结清扫术在内的同侧选择性颈淋巴结清扫术。我们分析了胸骨上淋巴结转移与性别、年龄、肿瘤特征及颈淋巴结转移状态之间的相关性。
11例（12.9%）患者有胸骨上淋巴结病理转移。胸骨上淋巴结转移与位于甲状腺下极的肿瘤及IV区淋巴结转移相关（分别为P = 0.005和0.014）。受试者工作特征曲线分析表明，两个或更多IV区转移淋巴结对胸骨上淋巴结转移具有最佳预测价值（P < 0.001）。
在cN1b期PTC患者中，尤其是那些甲状腺下极有肿瘤或IV区淋巴结转移的患者，应更加关注胸骨上淋巴结，并且胸骨上淋巴结清扫术应常规作为选择性颈淋巴结清扫术的一部分。
