关键词: 甲状腺乳头状癌, 中央区淋巴结, 颈淋巴结阴性, 预防性中央区淋巴结清扫

Abstract:

Objective  To investigate the indications and the extent of prophylactic central lymph node dissection in clinically node-negative（cN0）papillary thyroid carcinoma（PTC）. Methods

A total of 93 cases treated between Mar. 2015 and Dec. 2010 was analyzed retrospectively. The related clinicopathologic factors were analyzed, including sex, age, tumor size, extrathyroidal extension, and multifocal tumor, coexistence of Hashimoto’s thyroiditis. All the cases underwent total/near total thyroidectomy and Ipsilateral central lymph node dissection（IpsiCCD）. The removed lymph nodes were sent for frozen section examination（FSE）, and at last, the contralateral central lymph node dissection were performed. We compared the Results of FSE and postoperative pathological examination, to evaluate the accuracy of FSE in assessing the nodal status. Results Of these cases, 18 cases were males and 75 females, with a mean age of 41±13.9 years. T1, T2 and T3 diseases accounted for 65, 18 and 10 cases, respectively. The rates of CLN metastasis were 46.2%（43/93）, and the rates of bilateral CLN metastases were 18.2% （17/93）. The analysis showed that sex, age, tumor size, extrathyroidal extension, and multifocal tumor, coexistence of Hashimoto s thyroiditis have no relation with CLN metastases. The FSE had the sensitivity of 86.0%, specificity of 100% and overall accuracy of 93.5% in detecting occult ipsilateral central neck metastases in the unifocal cN0 PTC. Conclusion Ipsilateral CND should be employed for all cN0 PTC. FSE of ipsilateral nodes is accurate in determining nodal status. Routine IpsiCCD plus FSE of the ipsilateral nodes could be used to make the decision of contralateral central lymph node dissection in surgery.

Key words: papillary thyroid carcinoma （PTC）, central lymph node（CLN）, clinically node-negative （cN0）, central lymph node dissection（CLND）