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  

Value of intraoperative frozen pathological examination in evaluating lymph node involvement in papillary thyroid carcinoma

作　　者：王亚军[1] 康骅[1] 赵菁[1] 海涛[1] 张小丽[1] 蔡伟[1] Wang Yajun;Kang Hua;Zhao Jing;Hai Tao;Zhang Xiaoli;Cai Wei(Thyroid and Breast Disease Diagnosis and Treatment Center,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[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

出　　处：《肿瘤研究与临床》2022年第2期92-96,共5页Cancer Research and Clinic

摘　　要：目的:探讨术中选择性淋巴结冷冻病理检查对甲状腺乳头状癌(PTC)中央区淋巴结转移的预测作用。方法:选择2015年1月至2019年6月于首都医科大学宣武医院行初次甲状腺癌根治术及中央区淋巴结清扫术的721例PTC患者,患者均行术中选择性淋巴结冷冻病理检查。经石蜡切片病理诊断为甲状腺微小乳头状癌(PTMC)449例,非PTMC 272例。分析全组及经术后病理检查证实为中央区淋巴结阳性的按肿瘤长径分层患者(PTMC组192例、长径>1 cm且<2 cm组142例、长径≥2 cm组55例)术中喉前淋巴结、气管前淋巴结、气管旁淋巴结冷冻病理检查结果与术后中央区淋巴结石蜡病理结果的关系;以术后石蜡病理结果为金标准,计算术中冷冻病理检查诊断中央区淋巴结转移的灵敏度和假阴性率。结果:PTMC患者和非PTMC患者中分别有42.8%(192/449)和72.4%(197/272)患者伴中央区淋巴结转移。192例伴中央区淋巴结转移的PTMC患者中,术中冷冻病理检查喉前淋巴结、气管旁淋巴结、气管前淋巴结诊断中央区淋巴结转移的灵敏度分别为28.1%(47/167)、61.4%(70/114)、53.8%(91/169);术中冷冻病理结果诊断中央区淋巴结转移的灵敏度和假阴性率分别为72.4%(139/192)、27.6%(53/192)。197例伴中央区淋巴结转移的非PTMC患者中,术中冷冻病理检查喉前淋巴结、气管旁淋巴结、气管前淋巴结诊断中央区淋巴结转移的灵敏度分别为49.7%(82/165)、51.6%(96/186)、64.7%(112/173);术中冷冻病理结果诊断中央区淋巴结转移的灵敏度和假阴性率分别为84.8%(167/197)、15.2%(30/197)。PTMC组、长径>1 cm且<2 cm组、长径≥2 cm组中累及甲状腺被膜患者术中淋巴结冷冻病理结果诊断中央区淋巴结转移的灵敏度分别为81.7%(116/142)、81.7%(103/126)、92.2%(47/51)。结论:PTC颈部中央区淋巴结转移较为常见,术中选择喉前淋巴结、气管前淋巴结、气管旁淋巴结进行冷冻病理检查可有效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

关 键 词：甲状腺肿瘤 癌 乳头状 淋巴转移 术中冷冻病理 

分 类 号：R736.1[医药卫生—肿瘤]