Yoon Jee Hee, Park Ji Yong, Hong A Ram, Kim Hee Kyung, Kang Ho-Cheol
Department of Internal Medicine, Chonnam University Medical School, Gwangju, Republic of Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam University Hwasun Hospital, Gwangju, Republic of Korea.
Front Endocrinol (Lausanne). 2024 Jul 2;15:1392247. doi: 10.3389/fendo.2024.1392247. eCollection 2024.
Papillary thyroid microcarcinoma (PTMC) is characterized by its favorable prognosis and potential for active surveillance (AS) as a management option. However, the presence of cervical lymph node (LN) metastasis, especially lateral LN metastasis, significantly impacts management and prognosis. Previous studies have focused on post-surgery risk factors for cervical LN metastasis. This study aims to identify predictors of lateral LN metastasis by analyzing pre-operative ultrasonographic findings alongside clinicopathological factors.
A retrospective review of medical records was conducted for patients with PTMC who underwent surgery at Chonnam National University Hwasun Hospital between 2004 and 2013. This is a case-control study that compares patients with lateral LN metastasis (N1b) to age- and sex-matched patients without LN metastasis (N0). Subgroup analysis was performed to evaluate risk factors of skip metastasis.
The study included 90 patients with PTMC with lateral LN metastasis (N1b) and 268 age- and sex-matched patients without LN metastasis (N0). The mean age was 49.3 years, and female patients were dominant in both groups. Structural recurrences of 4.4% (4/90) were observed only in the N1b group. The N1b group exhibited a higher frequency of upper lobe tumor location compared to the N0 group (38.9% vs. 16.0%, < 0.001). There was no significant difference in the locations with the presence of invasion to adjacent organs. A higher proportion of non-parallel shape was observed in the N1b group than the N0 group (80.0% vs. 66.0%, = 0.013). There were no differences in echogenicity, sonographic feature, margin, and AP diameter of the thyroid gland between the two groups. In multivariate analysis, independent risk factors for lateral LN metastasis included extrathyroidal extension, multiplicity, upper lobe tumor location, and non-parallel shape. Skip metastasis in patients with PTMC was associated with upper lobe tumor location.
Detailed ultrasound examinations, evaluating tumor location, number, orientation, and the presence of ETE, are crucial in accurately predicting lateral LN metastasis especially when primary tumor was in the upper lobe to avoid missing skip metastasis. These evaluations can help guide the decision between AS and immediate surgery in patients with PTMC.
甲状腺微小乳头状癌（PTMC）的特点是预后良好，作为一种治疗选择具有积极监测（AS）的可能性。然而，颈部淋巴结（LN）转移的存在，尤其是侧方LN转移，会显著影响治疗和预后。以往的研究主要集中在手术后颈部LN转移的危险因素。本研究旨在通过分析术前超声检查结果以及临床病理因素来确定侧方LN转移的预测因素。
对2004年至2013年在全南国立大学和顺医院接受手术的PTMC患者的病历进行回顾性研究。这是一项病例对照研究，将有侧方LN转移（N1b）的患者与年龄和性别匹配的无LN转移（N0）患者进行比较。进行亚组分析以评估跳跃转移的危险因素。
该研究纳入了90例有侧方LN转移（N1b）的PTMC患者和268例年龄和性别匹配的无LN转移（N0）患者。平均年龄为49.3岁，两组均以女性患者为主。仅在N1b组中观察到4.4%（4/90）的结构复发。与N0组相比，N1b组上叶肿瘤位置的频率更高（38.9%对16.0%，<0.001）。在侵犯相邻器官的部位方面没有显著差异。N1b组中观察到非平行形状的比例高于N0组（80.0%对66.0%，=0.013）。两组之间甲状腺的回声、超声特征、边缘和前后径没有差异。在多变量分析中，侧方LN转移的独立危险因素包括甲状腺外扩展、多灶性、上叶肿瘤位置和非平行形状。PTMC患者的跳跃转移与上叶肿瘤位置有关。
详细的超声检查，评估肿瘤位置、数量、方向和ETE的存在，对于准确预测侧方LN转移至关重要，尤其是当原发肿瘤位于上叶时，以避免漏诊跳跃转移。这些评估有助于指导PTMC患者在AS和立即手术之间的决策。
