Di Meo Giovanna, Prete Francesco Paolo, De Luca Giuseppe Massimiliano, Pasculli Alessandro, Sgaramella Lucia Ilaria, Minerva Francesco, Logoluso Francesco Antonio, Calculli Giovanna, Gurrado Angela, Testini Mario
Unit of Academic General Surgery "V. Bonomo", Department of Biomedical Sciences and Human Oncology, University of Bari, Polyclinic Hospital, 70124 Bari, Italy.
Unit of Academic Internal Medicine "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari, Polyclinic Hospital, 70124 Bari, Italy.
Cancers (Basel). 2021 May 31;13(11):2737. doi: 10.3390/cancers13112737.
(1) Background: Lymph node metastases from papillary thyroid cancer (PTC) are frequent. Selective neck dissection (SND) is indicated in PTC with clinical or imaging evidence of lateral neck nodal disease. Both preoperative ultrasound (PreUS) and intraoperative palpation or visualization may underestimate actual lateral neck nodal involvement, particularly for lymph-nodes located behind the sternocleidomastoid muscle, where dissection may also potentially increase the risk of postoperative complications. The significance of diagnostic IOUS in metastatic PTC is under-investigated. (2) Methods: We designed a prospective diagnostic study to assess the diagnostic accuracy of IOUS compared to PreUS in detecting metastatic lateral neck lymph nodes from PTC during SND. (3) Results: There were 33 patients with preoperative evidence of lateral neck nodal involvement from PTC based on PreUS and fine-needle cytology. In these patients, IOUS guided the excision of additional nodal compartments that were not predicted by PreUS in nine (27.2%) cases, of which eight (24.2%) proved to harbor positive nodes at pathology. The detection of levels IIb and V increased, respectively, from 9% (PreUS) to 21% (IOUS) ( < 0.0001) and from 15% to 24% ( = 0.006). (4) Conclusions: In the context of this study, IOUS showed higher sensitivity and specificity than PreUS scans in detecting metastatic lateral cervical nodes. This study showed that IOUS may enable precise SND to achieve oncological radicality, limiting postoperative morbidity.
(1) 背景：甲状腺乳头状癌（PTC）发生淋巴结转移很常见。对于有临床或影像学证据表明存在侧颈淋巴结病变的PTC患者，建议行选择性颈清扫术（SND）。术前超声（PreUS）以及术中触诊或可视化检查都可能低估实际的侧颈淋巴结受累情况，尤其是对于位于胸锁乳突肌后方的淋巴结，在此处进行清扫还可能增加术后并发症的风险。术中超声（IOUS）在转移性PTC诊断中的意义尚未得到充分研究。(2) 方法：我们设计了一项前瞻性诊断研究，以评估在SND期间，IOUS与PreUS相比，在检测PTC转移性侧颈淋巴结方面的诊断准确性。(3) 结果：基于PreUS和细针穿刺细胞学检查，有33例患者术前有PTC侧颈淋巴结受累的证据。在这些患者中，IOUS引导切除了PreUS未预测到的额外淋巴结区域，共9例（27.2%），其中8例（24.2%）病理证实有阳性淋巴结。IIb区和V区淋巴结的检出率分别从PreUS的9%增至IOUS的21%（<0.0001）以及从15%增至24%（=0.006）。(4) 结论：在本研究中，IOUS在检测转移性侧颈淋巴结方面比PreUS扫描具有更高的敏感性和特异性。本研究表明，IOUS可能有助于实现精确的SND以达到肿瘤根治性，同时限制术后发病率。
