Cetinoglu Isik, Aygun Nurcihan, Yanar Ceylan, Caliskan Ozan, Kostek Mehmet, Unlu Mehmet Taner, Uludag Mehmet
Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye.
Sisli Etfal Hastan Tip Bul. 2023 Dec 29;57(4):458-465. doi: 10.14744/SEMB.2023.22309. eCollection 2023.
Unilateral or bilateral prophylactic central neck dissection (CND) in papillary thyroid cancer (PTC) is still controversial. We aimed to evaluate the risk factors for contralateral paratracheal lymph node metastasis and whether CND might be performed unilaterally.
Prospectively collected data of patients who underwent bilateral CND and lateral neck dissection (LND) with thyroidectomy due to PTC with lateral metastases, between January 2012 and November 2019, were evaluated retrospectively. The patients were divided into two groups according to the presence (Group 1) and absence (Group 2) of metastasis in the contralateral paratracheal region.A total of 42 patients (46 ±15.7 years) were operated. In the contralateral paratracheal region, Group 1 (35.7%) had metastases, while Group 2 (64.3%) had no metastases. In groups 1 and 2, metastasis rates were 100% vs 77.8% (p=0.073), 46.7% vs 18.5% (p=0.078), and 80% vs 40.7% (p=0.023) for the ipsilateralparatracheal, prelaryngeal and pretracheal lymph nodes, respectively.The number of metastatic lymph nodes in the central region was significantly higher in Group 1 compared to Group 2 as; 10.7±8.4 vs. 2.6±2.4 (p=0.001) in bilateral central region material; 8.3±7.4 vs. 2.9±2.7 (p=0.001) in lateral metastasis with ipsilateral unilateral central region; 3.8±3.4 vs. 1.9±1.9 (p=0.023) in ipsilateralparatracheal area; and 3.7±4.6 vs. 0.6±0.9 (p=0.001) in pretracheal region, respectively. However, no significant difference was found regarding the prelaryngeal region material (0.9±1.8 vs. 0.2±0.4 (p=0.71)).
2 metastatic central lymph nodes in unilateral CND material (AUC: 0.814, p<0.001, J=0.563) can estimate contralateral paratracheal metastasis with 93% sensitivity, 63% specificity, while >2 pretracheal metastatic lymph nodes (AUC: 0.795, p<0.001, J: 0.563) can estimate contralateral paratracheal metastasis with 60% sensitivity and 96.3% specificity.
In patients with lateral metastases, the rate of ipsilateralparatracheal metastasis is 85%, while the rate of contralateral paratracheal metastasis is 35.7%. The number of ipsilateral central region or pretracheal lymph node metastases may be helpful in predicting contralateral paratracheal lymph node metastases. Notably, unilateral CND may be performed in the presence of ≤ 2 metastases in the ipsilateral central region.
甲状腺乳头状癌（PTC）患者行单侧或双侧预防性中央区颈部淋巴结清扫（CND）仍存在争议。我们旨在评估对侧气管旁淋巴结转移的危险因素，以及是否可以单侧进行CND。
回顾性评估2012年1月至2019年11月期间因PTC伴侧方转移而接受双侧CND和侧方颈部淋巴结清扫（LND）及甲状腺切除术患者的前瞻性收集数据。根据对侧气管旁区域有无转移将患者分为两组（第1组和第2组）。共有42例患者（46±15.7岁）接受了手术。在对侧气管旁区域，第1组（35.7%）有转移，而第2组（64.3%）无转移。在第1组和第2组中，同侧气管旁、喉前和气管前淋巴结的转移率分别为100%对77.8%（p=0.073）、46.7%对18.5%（p=0.078）和80%对40.7%（p=0.023）。第1组中央区转移淋巴结数量明显高于第2组，双侧中央区材料中分别为10.7±8.4对2.6±2.4（p=0.001）；同侧单侧中央区伴侧方转移时分别为8.3±7.4对2.9±2.7（p=0.001）；同侧气管旁区域分别为3.8±3.4对1.9±1.9（p=0.023）；气管前区域分别为3.7±4.6对0.6±0.9（p=0.001）。然而，喉前区域材料方面未发现显著差异（0.9±1.8对0.2±0.4，p=0.71）。
单侧CND材料中>2个中央区转移淋巴结（AUC：0.814，p<0.001，J=0.563）可估计对侧气管旁转移，敏感性为93%，特异性为63%；而>2个气管前转移淋巴结（AUC：0.795，p<0.001，J：0.563）可估计对侧气管旁转移，敏感性为60%，特异性为96.3%。
在侧方转移患者中，同侧气管旁转移率为85%，而对侧气管旁转移率为35.7%。同侧中央区或气管前淋巴结转移数量可能有助于预测对侧气管旁淋巴结转移。值得注意的是，同侧中央区转移灶≤2个时可进行单侧CND。
