Lateral neck lymph node metastasis in cN0 papillary thyroid carcinoma
10.3760/cma.j.issn.1673-0860.2012.08.011
- VernacularTitle:甲状腺乳头状癌cN0患者颈侧区淋巴结转移规律的探讨
- Author:
Rui CHEN
1
;
Tao WEI
;
Ming ZHANG
;
Jie-Qing LI
;
Xiu-He ZOU
;
Bin-Hui FU
;
Li-Ping WANG
;
Yu-Lan PENG
;
Bu-Yun MA
;
Jing-Qiang ZHU
Author Information
1. 四川大学华西医院
- Keywords:
Thyroid neoplasms;
Carcinoma,papillary;
Radical neck dissection
- From:
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
2012;47(8):662-667
- CountryChina
- Language:Chinese
-
Abstract:
Objective To study the pattern of lymph node spread in papillary thyroid carcinoma (PTC) with clinically negative node(cN0).Methods A total of 106 patients with cN0 PTC who underwent total or subtoyal thyroidectomy plus unilateral or bilateral lateral neck dissection ( LND,level Ⅱ - Ⅴ or level Ⅰ - Ⅴ ) at West China Hospital of Sichuan University between April 2004 and August 2010 were analyzed retrospectively.Results The lateral neck lymph node metastasis in cN0 PTC was significantly associated with sex ( male,P =0.007 ),tumor stage ( T3/T4,P =0.006 ),tumor size ( ＞ 1 cm,P =0.014) and the number of positive central lymph nodes( ≥2,P ＜0.001 ),but not with age and multifocal tumor.Level Ⅲ (47/116,40.5％ ) was the most prevalent metastatic site,followed by level Ⅳ (41/116,35.3％),level Ⅱ (18/116,15.5％) and level Ⅴ (2/29,6.9％).Of the cases with lymph node metastases in level Ⅲ and Ⅳ,89.8％ ( 79/88 ) of primary thyroid tumors existed in the lower and middle sites of the thyroid lobes,while in the cases with lymph node metastases in level Ⅱ,77.8％ (14/18) of primary thyroid tumors in the upper sites of the thyroid lobes,and 83.3％ of cases with level Ⅱ metastases were accompanied with level Ⅲ metastases.Two cases with level Ⅴ metastases were accompanied with metastases in levels Ⅱ,Ⅲ and Ⅳ.Conclusions LND should be considered for cNO PTC in male,with T3/T4 lesions and positive central lymph nodes≥2,and the range of dissection should include level Ⅲ and Ⅳ.Dissection of level Ⅱ should be considered in cNO PTC with primary tumor localized in the upper site of the thyroid lobe or with level Ⅲ metastasis.Dissection of level Ⅴ should be considered at present of metastases in level Ⅱ,Ⅲ,and Ⅳ.For cN0 PTC with tumor size ＜ 1 cm,confined to the thyroid and without lymph node metastasis in the central compartment,LND is not recommended.
