Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany.
Department of General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, University of Duisburg-Essen, Essen, Germany.
Clin Otolaryngol. 2022 May;47(3):440-446. doi: 10.1111/coa.13919. Epub 2022 Feb 25.
The aim of this study was to define the suitability of microscopic lymphatic and venous invasion for prediction of lymph node and distant metastases in papillary thyroid cancer.
Stratification by microscopic lymphatic and venous invasion, and multivariable analyses on lymph node and distant metastases including microscopic lymphatic and venous invasion as independent variables.
Tertiary referral centre.
422 patients who had ≥5 lymph nodes removed at initial thyroidectomy.
Lymph node and distant metastases.
Patients with microscopic lymphatic invasion had larger primary tumours than patients without and more often revealed microscopic venous invasion, multifocal tumour growth and lymph node metastases. Patients with microscopic venous invasion exhibited larger primary tumours than patients without and more commonly had microscopic lymphatic invasion, poor tumour differentiation, lymph node metastases and distant metastases. Prediction of lymph node metastases by microscopic lymphatic invasion was better than prediction of distant metastases by microscopic venous invasion regarding sensitivity (61.0 vs. 33.3%) and positive predictive value (92.6 vs. 20.9%), comparable regarding specificity (89.6 and 93.4%), and worse regarding negative predictive value (51.9 vs. 95.3%) and accuracy (70.1 vs. 87.7%). On multivariable logistic regression analysis, microscopic lymphatic invasion was associated with lymph node metastasis (odds ratio [OR] 11.1) and multifocal tumour growth (OR 2.4), whereas primary tumour size (OR 5.8 for tumours >40 mm relative to tumours ≤20 mm) and multifocal tumour growth (OR 3.1) were associated with distant metastasis.
Stricter histopathological criteria are warranted to enhance the utility of microscopic vascular invasion for prediction of distant metastases in papillary thyroid cancer.
本研究旨在确定微观淋巴管和静脉侵犯对预测甲状腺乳头状癌淋巴结和远处转移的适宜性。
按微观淋巴管和静脉侵犯分层，并对包括微观淋巴管和静脉侵犯在内的淋巴结和远处转移进行多变量分析，将微观淋巴管和静脉侵犯作为独立变量。
三级转诊中心。
422 例在初始甲状腺切除术中至少切除 5 个淋巴结的患者。
淋巴结和远处转移。
有微观淋巴管侵犯的患者比无微观淋巴管侵犯的患者原发肿瘤更大，更常出现微观静脉侵犯、多灶性肿瘤生长和淋巴结转移。有微观静脉侵犯的患者比无微观静脉侵犯的患者原发肿瘤更大，更常出现微观淋巴管侵犯、肿瘤分化不良、淋巴结转移和远处转移。微观淋巴管侵犯预测淋巴结转移的敏感性（61.0%比 33.3%）和阳性预测值（92.6%比 20.9%）优于微观静脉侵犯预测远处转移，特异性（89.6%和 93.4%）相当，阴性预测值（51.9%比 95.3%）和准确性（70.1%比 87.7%）较差。多变量逻辑回归分析显示，微观淋巴管侵犯与淋巴结转移（优势比[OR] 11.1）和多灶性肿瘤生长（OR 2.4）相关，而原发肿瘤大小（OR 5.8，40mm 以上肿瘤相对于 20mm 以下肿瘤）和多灶性肿瘤生长（OR 3.1）与远处转移相关。
需要更严格的组织病理学标准来提高微观血管侵犯对预测甲状腺乳头状癌远处转移的实用性。
