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）

摘要：

目的 观察不同临床特点cN0期甲状腺乳头状癌患者的中央区淋巴结转移情况，探讨预防性中央区淋巴结清扫术的应用指征及手术范围。方法 回顾性分析2015年3月至2016年12月期间我院收治的93例甲状腺乳头状癌患者的病历及病理资料。分析患者性别、年龄、肿瘤大小、是否为多灶癌、肿瘤是否累及被膜等因素与中央区淋巴结转移率的关系。所有病例均行甲状腺全切除或近全切除术+患侧中央区淋巴结清扫术，并将患侧中央区标本送冰冻及石蜡病理检查，后再行对侧中央区淋巴结清扫术。观察中央区淋巴结转移情况及患侧中央区淋巴结冰冻与石蜡病理检查符合情况。结果 本组病例男性18例，女性75例；平均年龄41±13.9岁。T165例，T218例，T310例，T40例；单侧多灶癌8例；肿瘤突破甲状腺包膜9例。本组中央区淋巴结转移率为46.2%（43/93），18.2%（17/93）为双侧中央区淋巴结转移。性别、肿瘤位置、年龄、肿瘤直径、T分期等因素与CLN转移差异无统计学意义。患侧中央区淋巴结冰冻病理检查的敏感性、特异性、准确性分别为86.0%、100%、93.5%。结论 对cN0期甲状腺乳头状癌应常规行患侧中央区淋巴结清扫术；术中冰冻检查能准确预测患侧中央区淋巴结转移状态；术中应常规行冰冻切片检查，如患侧中央区淋巴结转移时，建议行双侧中央区淋巴结清扫术。

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