Chiapponi Costanza, Alakus Hakan, Schmidt Matthias, Faust Michael, Bruns Christiane J, Büttner Reinhard, Eich Marie-Lisa, Schultheis Anne M
Department of General, Visceral, Cancer and Transplant Surgery, University Clinic of Cologne, Cologne, Germany.
Department for Nuclear Medicine, University Clinic of Cologne, Cologne, Germany.
Front Med (Lausanne). 2022 Feb 21;9:841550. doi: 10.3389/fmed.2022.841550. eCollection 2022.
It is not mandatory to report lymphatic vessel invasion in pathology reports of papillary thyroid cancer (PTC) according to the current Union for International Cancer Control (UICC) TNM (tumor, nodes, and metastases) classification. However, there is some evidence for its correlation with lymph node metastasis (LNM) and prognosis. The aim of this study was to explore the clinical implication of lymphatic vessel invasion documentation of PTC because pathology reports play a pivotal role in postsurgical clinical decision-making in endocrine tumor boards.
Patients undergoing postoperative radioiodine treatment for PTC at the University Hospital of Cologne, Germany between December 2015 and March 2020 were identified. Pathology reports were screened for documentation of lymphatic vessel invasion. Demographics and clinicopathologic data of patients documented, including lymphatic vessel invasion and lymph nodal involvement were analyzed.
A total of 578 patients were identified and included. Lymphatic vessel invasion was reported in pathology reports of 366 (63.3%) and omitted in 112 (36.7%) patients. Positive lymphatic vessel invasion (L1) was diagnosed in 67 (18.3%) of 366 patients and was documented as absent (L0) in 299 (81.7%) patients. Lymph nodal (N) status was positive (N+) in 126 (45.6%) and negative (N0) in 150 (54.3%) of these patients. In 54 (80.6%) L1 cases N+ status and in 137 (65.6%) L0 cases N0 status was diagnosed. In 13 (19.4%) cases with L1 status, there were no LNMs (L1 N0). In total, 72 (34.4%) patients had LNM despite L0 status (L0 N+). The sensitivity and specificity of LVI reporting for LNM were 0.42 and 0.91, respectively.
In routine pathology reports of PTC used for indication to postoperative radioiodine treatment by a German endocrine tumor board, lymphatic vessel invasion was found to be reported inconsistently and mostly as L0. L1 diagnoses, however, reliably correlated with reported LNM and might, thus, be relevant for clinical decision-making. For this reason, we advocate for standardized pathologic reassessment of lymphatic vessel invasion, in particular for cases where lymph nodes are not included in the pathologic specimen and if L0 is documented.
根据国际癌症控制联盟（UICC）目前的TNM（肿瘤、淋巴结和转移）分类，在甲状腺乳头状癌（PTC）的病理报告中不必报告淋巴管侵犯情况。然而，有一些证据表明其与淋巴结转移（LNM）及预后相关。本研究的目的是探讨PTC淋巴管侵犯记录的临床意义，因为病理报告在内分泌肿瘤委员会的术后临床决策中起着关键作用。
确定2015年12月至2020年3月期间在德国科隆大学医院接受PTC术后放射性碘治疗的患者。筛查病理报告以查找淋巴管侵犯的记录。分析记录的患者的人口统计学和临床病理数据，包括淋巴管侵犯和淋巴结受累情况。
共确定并纳入578例患者。366例（63.3%）患者的病理报告中报告了淋巴管侵犯，112例（36.7%）患者未报告。366例患者中有67例（18.3%）被诊断为淋巴管侵犯阳性（L1），299例（81.7%）患者记录为无淋巴管侵犯（L0）。这些患者中，淋巴结（N）状态为阳性（N+）的有126例（45.6%），阴性（N0）的有150例（54.3%）。在54例（80.6%）L1病例中诊断为N+状态，在137例（65.6%）L0病例中诊断为N0状态。在13例（19.4%）L1状态的病例中，无淋巴结转移（L1 N0）。总共有72例（34.4%）患者尽管L0状态但仍有淋巴结转移（L0 N+）。LVI报告对LNM的敏感性和特异性分别为0.42和0.91。
在德国内分泌肿瘤委员会用于指示PTC术后放射性碘治疗的常规病理报告中，发现淋巴管侵犯的报告不一致，且大多报告为L0。然而，L1诊断与报告的LNM可靠相关，因此可能与临床决策相关。因此，我们主张对淋巴管侵犯进行标准化病理重新评估，特别是对于病理标本中未包含淋巴结且记录为L0的病例。
