示踪甲状腺乳头状癌侧颈淋巴结的前瞻性研究  

Lateral cervical lymph node mapping in papillary thyroid carcinoma:a prospective cohort study

作　　者：黄乃思 马奔 官青[1,2] 王蕴珺 周力 魏文俊 卢忠武 杨舒雯 徐伟博[1,2] 向俊 嵇庆海[1,2] 王宇 Naisi Huang;Ben Ma;Qing Guan;Yunjun Wang;Li Zhou;Wenjun Wei;Zhongwu Lu;Shuwen Yang;Weibo Xu;Jun Xiang;Qinghai Ji;Yu Wang(Department of Head and Neck Surgery,Fudan University Shanghai Cancer Center,Shanghai 200032,China;Department of Oncology, Shanghai Medical College,Fudan University,Shanghai 200032,China;Department of Surgical Oncology,Hangzhou First People's Hospital, Hangzhou 310006,China)

机构地区：[1]复旦大学附属肿瘤医院头颈外科,上海市200032 [2]复旦大学上海医学院肿瘤学系 [3]杭州市第一人民医院肿瘤外科

出　　处：《中国肿瘤临床》2018年第20期1053-1056,共4页Chinese Journal of Clinical Oncology

基　　金：上海市科学技术委员会科研计划项目(编号:16411966700);上海市卫生和计划生育委员会科研计划项目(编号:201640147);上海申康医院发展中心临床科技创新项目(编号:SHDC12016208)资助~~

摘　　要：目的:探索在甲状腺乳头状癌中纳米炭示踪侧颈部淋巴结的应用价值。方法:前瞻性地入组2016年3月至2017年11月复旦大学附属肿瘤医院接受甲状腺癌手术患者,术前超声或CT提示侧颈部淋巴结可疑转移,术中应用纳米炭混悬注射液进行侧颈部淋巴结示踪。结果:共67例患者接受了70例/侧颈部淋巴结示踪手术,侧颈部淋巴结转移57例(81.4%)。炭阳性淋巴结的中位检出数量为6枚。Ⅳ区炭染淋巴结无论在送检例数、送检淋巴结枚数以及转移淋巴结比例均为最高。Ⅲ～Ⅳ区淋巴结中炭阳性淋巴结的转移比例显著高于炭阴性淋巴结(P<0.001)。将最终颈清扫结果作为金标准,计算Ⅲ～Ⅳ区炭阳性淋巴结活检敏感度为86.0%。结论:纳米炭是甲状腺癌侧颈部淋巴结示踪的潜在方法。联合侧颈部Ⅲ～Ⅳ区炭阳性淋巴结活检,可以达到较高的敏感度,是较为合理的前哨淋巴结活检范围。Objective:To explore the value of nanoparticles(CN)in lateral cervical lymph node mapping in papillary thyroid carcinoma using carbon.Methods:Thyroid cancer patients with suspicious lymph node metastasis but without typical signs of metastatic disease fromMarch 2016 to November 2017 in Fudan University Shanghai Cancer Center were prospectively included in the cohort.Neck dissection was performed in all patients(compartmentsⅡ-Ⅴ).Suspicious lateral lymph node metastasis was identified using pre-operative ultrasound or computed tomography.CN were used for lymph node mapping during surgery.Results:A total of 70 surgeries were performed in 67 patients,among which 57 were found to have lateral lymph node metastasis(81.4%).The median number of CN-dyed lateral lymph nodes was 6.Compartment IV had the highest number of CN-dyed positive lymph nodes as well as the highest rate of metastasis,followed by compartmentⅢ.In compartmentsⅢandⅣ,the incidence of lymph node metastasis was significantly higher in the CN-dyed group than in the CN-undyed group(P<0.001).When the final pathology of neck dissection was set as the gold standard,lateral CN-dyed lymph node biopsy was found to have a sensitivity of 86.0%;its negative predictive value was 61.9%and its overall accuracy was 88.6%.Conclusions:Injection of CN during surgery was a potential method of mapping lateral lymph nodes in papillary thyroid carcinoma.CompartmentⅢ-ⅣCN-dyed lymph node biopsy had a satisfactory sensitivity and thus,served as a reasonable range for lymph node biopsy.

关 键 词：甲状腺乳头状癌 侧颈部淋巴结 淋巴结示踪 颈清扫 前哨淋巴结活检 

分 类 号：R736.1[医药卫生—肿瘤]