Clinical Research on Regularity of Lymph Node Metastasis in Papillary Thyroid Carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

REN Lijun ¹ , YANG Yanfang ² , ZHANG Chenglei ¹

1.Department of Thyroid and Breast Surgery, The Second Hospital of Liaocheng, Affiliated to Taishan Medical College, Linqing 252601, Shandong Province, China;;
2.Department of Neurology, The Second Hospital of Liaocheng, Affiliated to Taishan Medical College, Linqing 252601, Shandong Province, China;

Corresponding author：

Keywords：

Thyroid neoplasm; Papillary carcinoma; Cervical lymph node dissection

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ObjectiveTo study the regularity of cervical lymph node metastasis in papillary thyroid carcinoma and a reasonable surgical method. MethodsThe clinical data of 221 cases of papillary thyroid carcinoma treated in this hospital between September 2004 and September 2009 were analyzed retrospectively. ResultsThere were 32 cases treated with total thyroidectomy, 189 patients with subtotal thyroidectomy. Two hundred and two patients with unilateral thyroid carcinoma and 19 patients with bilateral thyroid carcinoma were diagnosed by pathology. The diameter of tumor was 0.2-8.0 cm with an average of 3.5 cm. The amicula invasion was found in 50 cases and mulifocality in 33 cases. The numbers of lymph node dissection were 10-24 with an average of 14.3 in unilateral. The total lymph node metastasis rate was 37.56% (83/221), the lymph node metastasis rate was 33.94% (75/221) in the Ⅵ region, and which was 18.10% (40/221) in the Ⅱ+Ⅲ+Ⅳ region. The rate of cervical lymph node metastasis markedly increased in the patients with the primary tumor diameter gt;1.0 cm, amicula invasion, multifocality, or age gt;45 years in the Ⅵ region and ipsilateral of Ⅱ+Ⅲ+Ⅳ region (P lt;0.05). ConclusionsIn patients with thyroid papillary carcinoma, the most common lymph node metastasis happened in the Ⅵ region, next in the Ⅱ+Ⅲ+Ⅳ region. Lymph nodes of the Ⅵ region should routinely be dissected in the first surgery, the lymph nodes of the Ⅱ+Ⅲ+Ⅳ region should be dissected when the tumor diameter gt;1.0 cm, amicula invasion, multifocality or ultrasonic, CT, and other imaging examinations demonstrated cervical lymph node metastasis.

Citation： REN Lijun ,YANG Yanfang,ZHANG Chenglei. Clinical Research on Regularity of Lymph Node Metastasis in Papillary Thyroid Carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(4): 419-422. doi: Copy

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13.	Frankenthaler RA, Sellin RV, Cangir A, et al. Lymph node metastasis from papillaryfollicular thyroid carcinoma in young patients [J]. Am J Surg, 1990, 160(4): 341343.
14.	Mirallié E, Visset J, Sagan C, et al. Localization of cervical node metastasis of papillary thyroid carcinoma [J]. World J Surg, 1999, 23(9): 970973.
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1. 刘小华, 张敬彬, 陈金剑, 等. 甲状腺乳头状癌中央区淋巴结清扫术临床分析 [J]. 海南医学, 2010, 21(20): 5859.
2. 于金明, 徐忠法. 肿瘤临床通鉴 [M]. 济南: 山东科学技术出版社, 2004: 369375.
3. Mazzaferri EL, Jhiang SM. Longterm impact of initial surgical and medical therapy on papillary and follicular thyroid cancer [J]. Am J Med, 1994, 97(5): 418428.
4. Shaha AR. Prognostic factors in papillary thyroid carcinoma and implications of large nodal metastasis [J]. Surgery, 2004, 135(2): 237239.
5. 边学, 徐震纲, 张彬, 等. 分化型甲状腺癌的颈淋巴转移规律 [J]. 中华耳鼻咽喉头颈外科杂志, 2006, 41(8): 599602.
6. 汤钊猷. 现代肿瘤学 [M]. 上海: 上海医科大学出版社, 1993: 817827.
7. 沈强. 甲状腺癌颈淋巴结清扫术的几点看法 [J]. 外科理论与实践, 2009, 14(4): 379381.
8. Haigh PI, Urbach DR, Rotstein LE. Extent of thyroidectomy is not a major determinant of survival in low or highrisk papillary thyroid cancer [J]. Ann Surg Oncol, 2005, 12(1): 8189.
9. 吴延升, 张仑, 王旭东, 等. 甲状腺乳头状癌预后多因素分析 [J]. 中国肿瘤临床, 2007, 34(22): 12941297.
10. Dionigi G, Dionigi R, Bartalena L, et al. Surgery of lymph nodes in papillary thyroid cancer [J]. Expert Rev Anticancer Ther, 2006, 6(9): 12171229.
11. Thompson GB, Hay ID. Current strategies for surgical management and adjuvant treatment of childhood papillary thyroid carcinoma [J]. World J Surg, 2004, 28(12): 11871198.
12. 李迅庚, 马宏岩, 金星. 甲状腺癌淋巴结微转移的研究 [J]. 中国普通外科杂志, 2007, 16(11): 10731075.
13. Frankenthaler RA, Sellin RV, Cangir A, et al. Lymph node metastasis from papillaryfollicular thyroid carcinoma in young patients [J]. Am J Surg, 1990, 160(4): 341343.
14. Mirallié E, Visset J, Sagan C, et al. Localization of cervical node metastasis of papillary thyroid carcinoma [J]. World J Surg, 1999, 23(9): 970973.
15. 任国胜, 苏新良. 分化型甲状腺癌颈淋巴结清扫术式的选择 [J]. 中国普外基础与临床杂志, 2010, 17(8): 765767.
16. Nationgal Comhprehensive Cancer Network. Guidelinge of Thyroid Cancer: in clinical practice guidelines in oncology [S]. Isted, 2005.
17. British Thyroid Association and Royal College of Physician. Guidelines for the Management of Thyoid cancer in Adults [S]. London, 2002.
18. 刘跃武, 高维生, 唐伟松. 应更好地规范甲状腺癌的初次手术 [J]. 中国普外基础与临床杂志, 2006, 13(3): 254255.
19. 杨元华, 王冬冬, 李永斌, 等. 甲状腺手术显露喉返神经的临床研究 [J]. 中国普通外科杂志, 2007, 16(11): 10441045.
20. Kim JM, Kim TY, Kim WB, et al. Lymphovascular invasion is associated with lateral cervical lymph node metastasis in papillary thyroid carcinoma [J]. Laryngoscope, 2006, 116(11): 20812085.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Research on Regularity of Lymph Node Metastasis in Papillary Thyroid Carcinoma

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