Department of General Surgeon, Medicana International Hospital, Samsun, Turkey.
Department of Internal Medicine, Ayancık Government Hospital, Sinop, Turkey.
Eur Arch Otorhinolaryngol. 2022 Aug;279(8):4017-4022. doi: 10.1007/s00405-022-07361-3. Epub 2022 Mar 31.
Lymph node metastasis is frequently detected in differentiated thyroid cancers. Central dissection is performed to the lymph nodes in patients with microscopic metastases in the intraoperative evaluation. Other indications for central dissections are tumor size and cervical lateral lymph node metastasis. We consider that the localization of thyroid cancer in the thyroid lodge may be another risk factor for central lymph node metastasis. For this reason, the purpose of the present study was to investigate the relations between thyroid cancer localization and lymph node metastasis in differentiated thyroid cancer patients who had no preoperative cervical metastases and who underwent total thyroidectomy, and peritracheal, perithyroidal, and central lymph node dissection.
A total of 213 differentiated thyroid cancer cases followed in our general surgery and endocrinology clinic between September 2016 and May 2020 were evaluated retrospectively. Based on the data in the files, the patients who underwent total thyroidectomy, and central, perithyroidal, and peritracheal lymph node dissection were included in the study. The patients were divided into four Groups according to tumor localizations, those with tumors adjacent to the trachea (Group 1), upper thyroid pole (Group 2), thyroid middle part (Group 3), thyroid inferior (Group 4). The demographic characteristics, laboratory parameters, cancer types, and lymph node metastasis rates of the Groups were evaluated.
A total of 84% (179) of the cases had thyroid papillary cancer, 11.73% (25) had thyroid follicular cancer, and 4.2% (9) had poorly differentiated thyroid cancer. The mean age of all patients was found to be 49 ± 8.3 years, and the female/male ratio was 2.4. It was found that the differentiated thyroid cancers metastasized to the perithyroidal, peritracheal, and central lymph nodes at a rate of 57.74%. The distribution of these metastases according to the Groups was; 62.85% in Group 1, 11.53% in Group 2, 43.9% in Group 3, and 88.57% in Group 4. It was also found that 80.32% of the papillary cancer cases and 57.14% of the follicular cancer cases metastasized to central (level VI) lymph nodes in Group 4.
The localization of differentiated thyroid cancers is a new risk factor for perithyroidal metastases.
分化型甲状腺癌常发生淋巴结转移。对于术中评估有镜下转移的患者，进行中央区淋巴结清扫术。中央区淋巴结清扫术的其他适应证包括肿瘤大小和颈部侧方淋巴结转移。我们认为甲状腺癌在甲状腺滤泡中的定位可能是中央淋巴结转移的另一个危险因素。因此，本研究旨在探讨无术前颈部转移且行甲状腺全切除术、甲状旁腺周围、甲状腺周围和中央区淋巴结清扫术的分化型甲状腺癌患者中，甲状腺癌定位与淋巴结转移之间的关系。
回顾性分析 2016 年 9 月至 2020 年 5 月在我院普外科和内分泌科就诊的 213 例分化型甲状腺癌患者的临床资料。根据病历资料，纳入行甲状腺全切除术和中央区、甲状旁腺周围、甲状腺周围淋巴结清扫术的患者。根据肿瘤位置将患者分为 4 组，气管旁（第 1 组）、甲状腺上极（第 2 组）、甲状腺中部（第 3 组）、甲状腺下极（第 4 组）。评估各组患者的一般资料、实验室参数、肿瘤类型和淋巴结转移率。
84%（179 例）的病例为甲状腺乳头状癌，11.73%（25 例）为甲状腺滤泡癌，4.2%（9 例）为低分化甲状腺癌。所有患者的平均年龄为 49±8.3 岁，男女比例为 2.4。研究发现分化型甲状腺癌向甲状腺周围、气管旁和中央淋巴结转移的比例为 57.74%。根据分组，这些转移的分布情况如下：第 1 组为 62.85%，第 2 组为 11.53%，第 3 组为 43.9%，第 4 组为 88.57%。研究还发现，第 4 组中 80.32%的乳头状癌和 57.14%的滤泡癌病例转移至中央（VI 区）淋巴结。
分化型甲状腺癌的定位是甲状腺周围转移的一个新的危险因素。
