甲状腺微小癌位置与颈淋巴结转移的关系

李磊; 杨洁; 王伟霖; 王虎

甲状腺微小癌位置与颈淋巴结转移的关系

云南省肿瘤医院头颈外科

基金项目:

基金：云南省卫生科技计划基金资助项目 (2012WS0035);

计量
- 文章访问数: 2431
- HTML全文浏览量: 873
- PDF下载量: 81
- 被引次数: 0
出版历程
- 收稿日期: 2018-02-21

The Correlation between the Location of Thyroid Papillary Microcarcinoma and Cervical Lymph Node Metastasis

Funds:

基金：云南省卫生科技计划基金资助项目 (2012WS0035);

摘要

摘要: 目的探寻甲状腺乳头状微小癌病灶位置与颈淋巴结转移的关系.方法回顾分析云南省肿瘤医院头颈外科2013年1月至2016年1月收治334例甲状腺乳头状微小癌患者的临床资料, 研究病灶位置、病灶大小、是否突破被膜等因素与颈部中央区淋巴结及颈侧区淋巴结转移的关系.结果甲状腺乳头状微小癌位于甲状腺上极时发生VI区淋巴结转移率为33.33% (26/104) , 中极为39.81% (43/108) , 下极为52.46% (64/122) , 肿瘤位于下极时更倾向于发生VI区淋巴结转移 (P<0.05) .发生颈侧区淋巴结转移者为46例 (46/334, 13.77%) , 上极肿瘤发生颈侧区淋巴结转移率为21.15% (22/104) , 中极为11.11% (12/108) , 下极为9.83% (12/122) , 病灶位于甲状腺上级时更倾向于发生颈侧区淋巴结转移 (P=0.030) , 其中3例 (6.5%) 患者无中央区淋巴结转移而直接发生跳跃式颈侧区淋巴结转移。颈侧区淋巴结转移的患者中发生肿瘤突破被膜的比率为30.43% (14/46) , 高于未发生淋巴结转移的患者人群的19.09% (55/288) (P<0.05) .结论甲状腺乳头状微小癌病灶位置与颈部淋巴结转移存在一定的相关性.
- 甲状腺乳头状癌 /
- 颈侧区淋巴结转移 /
- 颈中央区淋巴结转移
Abstract: Objective To investigate the relationship between the location of thyroid papillary microcarcinoma and cervical lymph node metastasis. Me thods The clinical data of 334 cases of thyroid papillary microcarcinoma were retrospectively analyzed. The location of the lesion, the size of the lesion, the situation of the capsule and other factors were compared in patients with central lymph nodes or/and cervical lymph node metastasis.Re s ults The lymph node metastasis rate were 33.33% (26/104) , 39.81% (43/108) , and 52.46% (64/122) , when the papillary thyroid microcarcinoma was located at the upper pole, median pole, and lower pole respectively (P<0.005) . There were 46 cases (46/334, 13.77%) with cervical lymph node metastasis. The metastasis rate of cervical lymph node were 21.15% (22/104) , 11.11% (12/108) , and 9.83% (12/122) , when the papillary thyroid microcarcinoma was located at the upper pole, median pole, and lower pole respectively (P = 0.003) . 3 patients (6.5%) had no central lymph node metastasis and direct skipping of the cervical lymph nod trensfer. The rate of tumor break through through the membrane in patients with cervical lymph node metastases was 30.43% (14/46) , which was higher than the 19.09% (55/288) of patients without lymph node metastasis (P <0.005) .Conclus ions There is a certain correlation between the location of papillary thyroid microcarcinoma and cervical lymph node metastasis.
- Papillary thyroid carcinoma /
- Lateral lymph node metastasis /
- Central lymph node metastasis

HTML全文

参考文献(20)

[1]	[1]WITT R L.What is the best treatment of incidental papillary thyroid microcarcinoma Laryngoscope 2016;126:2203-2204[J].Jemal A, Murray T, Samuels A, et al.Cancer statistics, 2003.CA Cancer J Clin, 2003, 53 (10) :5-26.
[2]	[2] LUNDGREN C I, HALL P, DICKMAN P W, et al.Clinically significant prognostic factors for differentiated thyroid carcinoma:a population-based, nested case-control study[J].Cancer, 2006, 106 (3) :524-531.
[3]	[3]GLOVER A R, GUNDARA J S, NORL N O, et al.The pros and cons of prophylactic central neck disection in papilary thyroid carcinoma[J].Gland Surg, 2013, 2 (4) :196-205.
[4]	[4]COOPER D S, DOHERTY G M, HAUGEN B R, et al.Revised American Thyroid Asociation management guidelines for patients with thyroid nodules and diferentiated thyroid cancer[J].Thyroid, 2009, 19 (11) 11:1167-1214.
[5]	[5]HAUGEN B R M, ALEXANDER E K, BIBLE K C, et al.2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer[J].Thyroid, 2015, 123 (3) :372-381.
[6]	[6]WADA N, DUH QY, SUGINO K, et al.Lymph node metastasis from 259 papillary thyroid microcarcinomas:frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection[J].Ann Surg, 2003, 273 (3) :399-407.
[7]中国抗癌协会头颈肿瘤专业委员会.分化型甲状腺癌诊治指南[J].中国实用外科杂志, 2011, 31 (10) :908-914.
[8]	[8]LEE Y S, LIM Y S, LEE J C, et al.Clinical implication of the number of central lymph node metastasis in papillary thyroid carcinoma:preliminary report[J].World J Surg, 2010, 34 (11) :2558-2563.
[9]	[9]KIM E, PARK J S, SON K R, et al.Preoperative diagnosis of cervical metastatic lymph nodes in papillary thyroid carcinoma:comparison of ultrasound, computed tomography, and combined ultrasound with computed tomography[J].Thyroid, 2008, 18 (4) :411-418.
[10]	[10]EUN Y G, LE Y C, KWON K H.Predictive factors of contralateral paratracheal lymph node metastasis in papilary thyroid cancer:prospective multicenter study[J].Otolaryngol Head Neck Surg, 2014, 150 (2) :210-215.
[11]	[11]KUPFERMAN M E, PATTERSON M, MANDEL SJ, et al.Patterns of lateral neck metastasis in papillary thyroid carcinoma[J].Arch Otolaryngol Head Neck Surg, 2004, 130 (7) :857-860.
[12]	[12]LUNDGREN C I, HALL P, DICKMAN P W, et al.Clinically significant prognostic factors for differentiated thyroid carcinoma:a population-based, nested case-control study[J].Cancer, 2006, 3 (3) :524-531.
[13]	[13]LE K E, CHUNG I Y, KANG E, et al.Ipsilateral and contralateral central lymph node metastasis in papilary thyroid cancer:paterns and predictive factors of nodal metastasis[J].Head Neck, 2013, 35 (5) :672-676.
[14]	[14]MACHENS A, HOLZHAUSEN H J, DRALLE H.Skip metastases in thyroid cancer leaping the central lymph node compartment[J].Arch Surg, 2004, 139 (1) :43-45.
[15]	[15]DUCCI M, APPETECCHIA M, MARZETTI M.Neck dissection for surgical treatment of lymphnode metastasis in papillary thyroid carcinoma[J].J Exp Clin Cancer Res, 1997, 6 (3) :333-335.
[16]	[16]KOO B S, LIM H S, LIM Y C, et al.Occult contralateral carcinoma in patients with unilateral papillary thyroid microcarcinoma[J].Ann Surg Oncol, 2010, 7 (4) :1101-1105.
[17]	[17]LEE B J, WANG S G, LEE J C, et al.Level IIb lymph node metastasis in neck dissection for papillary thyroid carcinoma[J].Arch Otolaryngol Head Neck Surg, 2007, 133 (10) :1028-30.
[18]	[18]LEE Y S, SHIN S C, LIM Y S, et al.Tumor location-dependent skip lateral cervical lymph node metastasis in papillary thyroid cancer[J].Head Neck, 2014, 36 (6) :887-891.
[19]	[19]KONTUREK A, BARCZYNSKI M, NOWAK W, et al.Risk of lymph node metastases in multifocal papilary thyroid cancer asociated with Hashimoto’s thyroiditis[J].Langenbecks Arch Surg, 2014, 399 (2) :229-236.
[20]	[20]CAI Y F, WANG Q X, NI C, et al.The clinical relevance of psammoma body and hashimoto thyroiditis in papillary thyroid carcinoma:a large case-control study[J].Medicine, 2015, 94 (44) :1-8.

相关文章(20)

[1]	韦琳, 朱梅, 张海琳, 冯煜然, 陈熙, 吴白领, 杨阳. 基于FNA-Tg和血清Tg的二元Logit回归模型对甲状腺癌淋巴结转移或复发的判定价值, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20230219
[2]	张冉, 杨洁, 冯恩梓, 袁晓凤, 王清. 甲状腺乳头状癌基因突变与其侵袭性相关性研究, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20230223
[3]	李诗洲, 何晓光, 林雁, 李玉晓, 杨曦, 王晓雨, 杨声豪. 原发灶不明颈部淋巴结转移鳞状细胞癌的临床分析, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20220710
[4]	熊世锋, 邹浩. 胆囊癌淋巴结转移的危险因素分析, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20220318
[5]	张海琳, 朱梅, 杨阳, 韦琳, 陈熙, 吴白领. 超声引导FNA及FNA-Tg识别甲状腺乳头状癌淋巴结转移的临床价值, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20221220
[6]	赵雯, 柯腾飞, 胡兴月, 赵仁杰. 双能量CT能谱曲线预测甲状腺乳头状癌颈部中央区淋巴结隐匿性转移的价值, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20221028
[7]	陆健斐, 卜锐, 刘小艳, 张幸, 丁昱, 章然. 常规超声与超声造影对甲状腺乳头状癌患者侧颈区淋巴结转移的术前诊断效能, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20221214
[8]	袁野, 常剑, 刘冬波, 姜保成. 混合型早期胃癌淋巴结转移情况及对预后的影响, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20210321
[9]	曹亚, 张辉, 孟林, 倪焕然, 赵一, 王光彦, 刘志莹, 杨晓梅, 杨丽春. 彩色超声、FNA-C、FNA-Tg在诊断甲状腺乳头状癌（PTC）颈部淋巴结转移中的价值, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20211119
[10]	任艳鑫, 廖曼各, 杨洁, 王晓莉, 李晓江. ER、HER-2在甲状腺乳头状癌中的表达及临床意义, 昆明医科大学学报.
[11]	华杰, 阮凌玉, 马定乾, 左晓霜, 向润清, 方山丹, 范源. 熊果酸诱导甲状腺乳头状癌细胞TPC-1凋亡的实验, 昆明医科大学学报.
[12]	徐嵘. 超声检测气管旁淋巴结对自身免疫甲状腺炎的诊断价值, 昆明医科大学学报.
[13]	杨雪君. 能谱曲线与常规形态学方法对结直肠癌转移淋巴结诊断准确性的对比, 昆明医科大学学报.
[14]	杨宏军. 甲状腺乳头状癌诊治199例分析, 昆明医科大学学报.
[15]	孙瑞梅. Focus超声刀在桥本氏甲状腺炎并甲状腺乳头状癌手术中的应用, 昆明医科大学学报.
[16]	李书聆. GST-π在喉癌及淋巴结微转移中的表达及其临床意义, 昆明医科大学学报.
[17]	党勇. 64排CT联合血清学检查对非小细胞性肺癌纵隔淋巴结转移的诊断, 昆明医科大学学报.
[18]	高河云. 淋巴结疾病的彩色多普勒超声诊断价值研究, 昆明医科大学学报.
[19]	高河云. 淋巴结疾病的彩色多普勒超声诊断价值研究, 昆明医科大学学报.
[20]	陈永生. 阴茎恶性黑色素瘤并双侧腹股沟淋巴结转移1例报道, 昆明医科大学学报.