The clinical value of lateral neck exploration in papillary thyroid carcinoma with negative result of lymph nodes fine-needle aspiration
10.3760/cma.j.cn113855-20240914-00591
- VernacularTitle:侧颈探查在淋巴结细针穿刺阴性甲状腺乳头状癌中的临床价值
- Author:
Yiwei WANG
1
;
Wang LI
;
Shengying WANG
Author Information
1. 安徽省肿瘤医院甲状腺外科，合肥 230001
- Publication Type:Journal Article
- Keywords:
Thyroid cancer, papillary;
Punctures;
Lymphatic metastasis
- From:
Chinese Journal of General Surgery
2024;39(12):914-918
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical value of intraoperative lateral neck exploration in papillary thyroid carcinoma (PTC) patients with negative result of fine-needle aspiration cytology (FNAC) on suspected lateral cervical lymph nodes (LLNs).Methods:From Jan 2022 to Dec 2023, a total of 100 PTC patients with ultrasound-suspected metastatic LLNs while FNAC were negative were prospectively enrolled . Lateral neck exploration was performed during radical surgery, and the range of lateral cervical lymph node dissection (LLND) was determined according to the intraoperative frozen pathological results.Results:Among the 100 patients, 62 cases of lateral cervical lymph node metastasis (LLNM) were confirmed by intraoperative frozen pathology, and 62 cases of LLND were performed. A total of 69 cases of LLNM were confirmed by postoperative routine pathology. Compared with the non-LLNM group, multifocal PTC was more likely to have LLNM ( RR=1.493, χ2=8.911, P=0.003). The main lesion of the LLNM group was larger [(15.96±9.62) mm vs. (12.55±4.79) mm, t=-2.362, P=0.020], and the central lymph node metastasis rate was higher [(43.59%±27.02%) vs. (23.83%±26.24%), t=-3.411, P=0.001]. The LLNs in the LLNM group showed more typical characteristics on ultrasound, such as localized inhomogeneous cortical thickening, cortical strip mass hyperechoic area, echoless area, and marginal or mixed blood flow. The accuracy rates of FNAC and intraoperative frozen pathology were 87.61% and 93.00%, respectively, and the missed diagnosis rates were 13.12% and 10.14%, respectively. Conclusions:In PTC with ultrasound-suspected metastatic LLNs while FNAC were negative, intraoperative lateral neck exploration can improve the diagnosis rate of LLNM and reduce the missed diagnosis of LLNM.
