Value of intraoperative frozen pathological examination in evaluating lymph node involvement in papillary thyroid carcinoma
10.3760/cma.j.cn115355-20210521-00227
- VernacularTitle:术中冷冻病理检查评估甲状腺乳头状癌淋巴结受累的价值
- Author:
Yajun WANG
1
;
Hua KANG
;
Jing ZHAO
;
Tao HAI
;
Xiaoli ZHANG
;
Wei CAI
Author Information
1. 首都医科大学宣武医院甲状腺乳腺疾病诊疗中心，北京 100053
- Keywords:
Thyroid neoplasms;
Carcinoma, papillary;
Lymphatic metastasis;
Intraoperative frozen pathology
- From:
Cancer Research and Clinic
2022;34(2):92-96
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the predictive effect of intraoperative selective lymph node frozen pathological examination on central lymph node metastasis in thyroid papillary carcinoma (PTC).Methods:A total of 721 PTC patients who underwent primary radical thyroidectomy and central lymph node dissection in Xuanwu Hospital of Capital Medical University from January 2015 to June 2019 were selected. All patients underwent intraoperative selective lymph node frozen pathological examination. According to the paraffin section pathological diagnosis results, there were 449 cases of thyroid micropapillary carcinoma (PTMC) and 272 cases of non-PTMC. The association of the frozen pathological examination results of intraoperative prelaryngeal lymph nodes, anterior tracheal lymph nodes and paratracheal lymph nodes with the pathological results of postoperative central lymph nodes was analyzed in all patients and those with central lymph node positive confirmed by postoperative pathological examination in different groups stratified by tumor long diameter, including 192 cases in PTMC group, 142 cases in long diameter >1 cm and <2 cm group and 55 cases in long diameter ≥2 cm group; postoperative paraffin pathological results were treated as the gold standard. The sensitivity and false negative rate of intraoperative frozen pathological examination in the diagnosis of central lymph node metastasis were calculated.Results:There were 42.8% (192/449) and 72.4% (197/272) of PTMC patients and non-PTMC patients with central lymph node metastasis, respectively. Among 192 PTMC patients with central lymph node metastasis, the sensitivity of prelaryngeal lymph nodes, paratracheal lymph nodes and anterior tracheal lymph nodes was 28.1% (47/167), 61.4% (70/114) and 53.8% (91/169), respectively based on the intraoperative frozen pathological diagnosis. The sensitivity and false negative rate of intraoperative frozen pathological examination in the diagnosis of central lymph node metastasis was 72.4% (139/192) and 27.6% (53/192), respectively. Among 197 non-PTMC patients with central lymph node metastasis, the sensitivity of prelaryngeal lymph nodes, paratracheal lymph nodes and anterior tracheal lymph nodes was 49.7% (82/165), 51.6% (96/186) and 64.7% (112/173), respectively based on the intraoperative frozen pathological results. The sensitivity and false negative rate of intraoperative frozen pathological examination in the diagnosis of central lymph node metastasis was 84.8% (167/197) and 15.2% (30/197), respectively. The sensitivity of intraoperative lymph node frozen pathological results in the diagnosis of central lymph node metastasis for patients with thyroid capsule involvement in PTMC group, long diameter > 1 cm and < 2 cm group and long diameter ≥ 2 cm group was 81.7% (116/142), 81.7% (103/126) and 92.2% (47/51), respectively.Conclusions:Cervical central lymph node metastasis of PTC is common. Intraoperative frozen pathological examination of prelaryngeal lymph nodes, anterior tracheal lymph nodes and paratracheal lymph nodes can effectively predict whether the central lymph nodes are involved, and this hint is more obvious when the tumor long diameter is more than 2 cm and the thyroid capsule is involved.
