Department of Head and Neck, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, China.
State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center (SYSUCC), Guanghzou, China.
Front Endocrinol (Lausanne). 2022 Jun 9;13:865911. doi: 10.3389/fendo.2022.865911. eCollection 2022.
Guidelines for prophylactic dissection in clinical central negative node (cN0) of papillary thyroid carcinoma vary among different countries due to the uncertainty on the benefit of dissection. The Chinese guidelines recommend prophylactic central compartment lymph node dissection (pCLND) under professional technology. Preoperative ultrasound (US) evaluation of central lymph node determines the surgical strategy used. Sensitivity differs significantly when US is conducted by different physicians even in diverse hospitals. In this study, the aim was to explore why the Chinese guidelines were different from the America Thyroid Association (ATA) guidelines through the real-world evidence on the preoperative diagnosis of cN0.
Preoperative US and surgical pathology data for 1,015 patients with PTC attending 13 Grade-A tertiary hospitals in 2017 were collected. A retrospective analysis using US assessment of CLNM was the conducted to explore the benefits of this approach in China. US physicians in our hospital were trained on scanning the thyroid gland and its regional lymph nodes in normalization. Data of 1,776 patients were collected under the same condition from 2012 to 2017, whose ultrasonography was performed by diverse physicians and doctors. Further, data of 339 patients evaluated by the same sonographer and operated by the same surgical team was collected between 2015 and 2017. In this set of data, US combined CT versus US alone was compared. Patients were grouped into metastasis group and non-metastasis group based on postoperative pathological diagnosis of CLNM. Diagnostic efficacy of US was evaluated.
A total of 925 patients who underwent preoperative ultrasonography in central lymph node, including 825 cases who underwent thyroidectomy and central lymph node dissection were included in this study. The sensitivity of ultrasonography in detecting CLNM was 23.18%, with occult metastasis rate of 40.8%. Data for 1,776 patients comprising paired ultrasonic report and pathological report were collected in our hospital, whose physicians underwent standardized training. The sensitivity was 37.58%. Furthermore, specialized evaluation showed high sensitivity in US/CT (84.58%) than US (58.21%) alone.
Although the sensitivity of US could be enhanced by standardized training and combination with CT, the prevalence of low sensitivity of US in real-world multicenter data and the high occult metastasis rate indicated that the Chinese guidelines were based on the current conditions.
由于对解剖的益处存在不确定性，不同国家对临床中央阴性淋巴结（cN0）的乳头状甲状腺癌预防性解剖的指南也有所不同。中国指南建议在专业技术下进行预防性中央隔室淋巴结清扫术（pCLND）。术前超声（US）评估中央淋巴结决定了所使用的手术策略。即使在不同的医院，不同医生进行的 US 检查，其敏感性也有很大差异。在这项研究中，我们旨在通过 cN0 术前诊断的真实世界证据，探讨为什么中国指南与美国甲状腺协会（ATA）指南不同。
收集了 2017 年 13 家甲级三级医院 1015 例 PTC 患者的术前 US 和手术病理数据。对 CLNM 的 US 评估进行回顾性分析，以探讨该方法在中国的优势。我院 US 医师对甲状腺及其区域淋巴结进行了规范化扫描培训。2012 年至 2017 年，在相同条件下收集了 1776 例患者的数据，这些患者的超声检查由不同的医生进行。进一步收集了 2015 年至 2017 年期间由同一位超声医师评估、由同一位手术团队进行手术的 339 例患者的数据。在这组数据中，比较了 US 联合 CT 与单独 US 的结果。根据术后 CLNM 病理诊断，将患者分为转移组和非转移组。评估了 US 的诊断效果。
本研究共纳入 925 例行中央淋巴结术前超声检查的患者，其中 825 例行甲状腺切除术和中央淋巴结清扫术。超声检查对 CLNM 的敏感性为 23.18%，隐匿性转移率为 40.8%。我院共收集了 1776 例有配对超声报告和病理报告的数据，这些医生都接受了标准化培训。敏感性为 37.58%。此外，专门评估显示，US/CT（84.58%）的敏感性高于 US（58.21%）。
尽管通过标准化培训和结合 CT 可以提高 US 的敏感性，但真实世界多中心数据中 US 敏感性低的普遍性和高隐匿性转移率表明，中国的指南是基于当前的情况。
