甲状腺微小乳头状癌颈淋巴结转移的危险因素分析  

Risk factor analysis for cervical nodal metastasis in papillary microcarcinoma

作　　者：卞雪艳 孙姗姗[1] 郭文宇[1] 赵明慧[1] 孔令平[1] 张仑[1] 

机构地区：[1]天津医科大学肿瘤医院颌面耳鼻喉肿瘤科国家肿瘤临床医学研究中心天津市肿瘤防治重点实验室,天津市300060

出　　处：《中国肿瘤临床》2015年第13期658-662,共5页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨甲状腺微小乳头状癌颈淋巴结转移的危险因素,分析高分辨率B超对侧颈淋巴结转移的诊断意义。方法:回顾性分析2013年1月至2013年11月天津医科大学肿瘤医院共1 037例甲状腺微小乳头状癌患者的临床病理资料。结果:1 037例患者中央区淋巴结转移率为32.02%(332例),侧颈淋巴结转移率为6.85%(71例)。男性、年龄≤45岁、肿瘤直径>5 mm、多灶性、双发性、侵犯包膜和甲状腺外局部侵犯者中央区淋巴结转移率较高(P<0.05)。男性、中央区淋巴结转移、B超诊断阳性者侧颈淋巴结转移率较高,并且随着中央区淋巴结转移数目的增多,侧颈转移率也随之增高(P<0.05)。高分辨率B超对侧颈淋巴结转移的灵敏度、特异度分别为92.96%、81.48%。结论:对中央区淋巴结转移高危因素的人群应行预防性中央区淋巴结清扫术,高分辨率B超对预测甲状腺微小乳头状癌患者颈淋巴结转移具有重要的诊断意义,对侧颈淋巴结转移高危因素的人群应行患侧侧颈淋巴结清扫术。Objective： To investigate the risk factors of central lymph node metastasis（CLNM） and lateral neck lymph node metastasis in papillary thyroid microcarcinoma（PTMC） patients, and to analyze the importance of high resolution ultrasonography in the diagnosis of lateral neck lymph node metastasis in PTMC patients. Methods： A retrospective protocol was applied, and a total of 1 037 PTMC patients were reviewed. These patients underwent central lymph node dissection or thyroidectomy with lateral neck lymph node dissection between January and November in 2013 in the Tianjin Medical University Cancer Institute and Hospital. Clinicopathological factors, namely, age, sex, primary tumor size, multifocality, bilateralism, thyroid capsular invasion, and local invasion, were analyzed.Results： CLNMs were found in 332 of 1037 patients（32.0%）, and 71 out of 1037 patients had lateral neck lymph node metastasis（6.85%）. In the univariate analysis, patients with the following risk factors were at high risk of CLNM（P〈0.05）： male, aged ≤45 years old, with primary tumor size of 5 mm, multifocality, bilateralism, thyroid capsular invasion, and local invasion. Male patients with central lymph node metastasis positively showed high lateral neck lymph node metastasis rate（P〈0.05） according to high-resolution ultrasonography diagnosis. The rate of lateral neck lymph node metastasis increased with increasing number of central lymph node metastases. The sensitivity and specificity of high resolution ultrasonography for lateral neck lymph node metastasis were 92.96% and 81.48%in PTMC patients.Conclusion： Prophylactic central compartment lymph node dissection needs to be performed in patients with CLNM risk factors（i.e., male, aged ≤45 years old, primary tumor size of 〉5 mm, multifocality, bilateralism, thyroid capsular invasion, and local invasion）. The importance of high-resolution ultrasonography in diagnosing lateral neck lymph node metastasis was revealed by the results. Thus, this method should

关 键 词：甲状腺微小乳头状癌 颈淋巴结清扫术 B超 诊断 

分 类 号：R736.1[医药卫生—肿瘤]