Role of level Ⅵ lymph nodes metastasis in cervical metastasis of patients with papillary thyroid cancer
10.3760/cma.j.issn.1673-0860.2010.08.012
- VernacularTitle:Ⅵ区淋巴结在甲状腺乳头状癌颈淋巴转移中的意义
- Author:
Xue BIAN
1
;
Hui CHEN
;
Xing YE
;
Ping-Zhang TANG
Author Information
1. 解放军北京军区总医院
- Keywords:
Thyroid neoplasms;
Carcinoma,papillary;
Lymphatic metastasis;
Neck dissection;
Biopsy
- From:
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
2010;45(8):664-668
- CountryChina
- Language:Chinese
-
Abstract:
Objective To study the features of level Ⅵ lymph node metastasis in papillary thyroid cancer (PTC) and the distribution of metastastic lymph nodes in the neck levels, and to provide evidences for the treatments of cervical metastasis in patients with PTC. Methods Ninety-seven PTC cases were reviewed retrospectively. The tumors in all cases were limited to one side lobe. Of them, 72 patients were cN0 and 25 patients were cN +; 32 patients with tumors ≤ 1 cm and 65 patients with tumors ＞ 1 cm.Pathological examinations of frozen biopsies of level Ⅲ and Ⅳ lymph nodes were taken in the operation. The extent of lymph node dissection depending on pathological examination results of level Ⅲ and Ⅳ lymph nodes and the size and location of the tumor. For the patients with metastastic lymph nodes in level Ⅲ and Ⅳ, the modified neck dissection including level Ⅵ was performed. Ipsilateral Ⅵ lymph node dissection was performed for the patients with tumors ≤ 1 cm and bilateral Ⅵ lymph node dissection for the patients with tumors ＞ 1 cm or with extra-thyroidal invasion. Results In 97 patients, 122 sides of Ⅵ lymph node dissection were performed. Positive nodes in level Ⅵ were found in 45.1% (55/122) patients. The positive rates of nodes metastases in level Ⅵ were 45.8% (33/72)for 72 patients with cN0 and 76.0% ( 19/25 ) for 25 patients with cN + respectively, with a significant difference statistically ( x2 = 6.790, P = 0.009 ).Positive rates of node metastases in level Ⅵ were 65.0% ( 13/20 ) in 10 patients with extra-thyroidal invasion and 41.2% (42/102) in 77 patients without extra-thyroidal invasion respectively, with a significant difference statistically (x2 = 3.833, P = 0.047 ). Positive rate of node metastasis in level Ⅵ was 43.8%(14/32) in 32 patients with tumors≤1cm. Of 65 patients with tumors ＞ 1cm, ipsilateral and bilateral node metastasis rates were 69.2% (45/65) and 23.1% (15/65) respectively, with a significant difference statistically (x2 = 5.843, P=0.016). Conclusions Cervical lymph node metastasis in level Ⅵ can occur at early stage of PTC. The patients with extra-thyroidal invasion were prone to have lymph node metastasis in level Ⅵ. Ipsilateral positive nodes in level Ⅵ can exist in the patients with tumors ≤ 1 cm, while bilateral positive nodes in level Ⅵ can occur in the patients with tumors ＞ 1 cm. The cervical lymph node metastasis of PTC may take place in level Ⅵ alone or in level Ⅳ and in lateral neck levels simultaneously. Pathological examinations of frozen biopsies of level Ⅲ and Ⅳ lymph nodes should be taken for PTC patients, when the presence of positive lymph node, the modified neck dissection including level Ⅵ should be performed.
