The Features of Lymph Node Metastasis of Differentiated Thyroid Carcinoma and the Choice of Lateral Neck Lymph Nodes Dissection

摘要

Objective: The clinicopathologic features of central area and lateral neck lymph nodes metastasis were retrospectively analyzed in order to better understand the characteristics of cervical lymph node metastasis, and provide an objective reasonable choice basis of surgical treatment cervical lymph node for the surgeons. Methods: All patients from January 2008 to July 2010 in our hospital were collected, 329 cases of resection of thyroid cancer and central lymph node dissection treatment of PTC were analyzed (Including 115 cases of lateral neck lymph nodes dissection at the same time). We then analyzed the correlation between the clinicopathological features of central lymph nodes and lateral lymph node metastasis. Results: The average age of 329 cases of patients was 43 years, male 66 cases, female 263 cases, tumor diameter average 1.11cm, the average number of tumors 1.76, 97 cases of bilateral, 232 cases of unilateral, 44.07% of central lymph node metastasis in 329, 57.39% of lateral lymph node metastasis in 115 cases of lateral neck lymph nodes dissection, 35.11% of central lymph node metastasis in 262 cases of patients with a clinical negative result of central lymph nodes preoperative examination, 28.81% of lateral lymph node metastasis in 59 cases of patients with a negative result of lateral lymph nodes preoperative examination. (1) Papillary thyroid carcinoma those who were in the groups of male, >45 years old, associated with extrathyroidal invasion, the diameter >1cm, absence of other thyroid diseases, absence of nodular goiter had a higher rate of central lymph node metastasis (P=0.028, 0.003, 0.001, 0.000, 0.000, 0.001, respectively). And the group that Ultrasonography examination showed a positive result of central lymph nodes had a higher rate of central lymph node metastasis than the group that Ultrasonography showed a negative result (P=0.000). (2) Papillary thyroid carcinoma those who were in the groups of male, >45 years old, unilateral tumor had a higher rate of lateral lymph node metastasis (P=0.040, 0.008, 0.021, 0.000). And the group of central lymph node metastasis positive had a higher rate of lateral lymph node metastasis than the group of central lymph node metastasis negative (P=0.000). (3) Those clinically examination negative central lymph nodes metastasis papillary thyroid carcinoma who were in the groups of the diameter > 1cm, absence of other thyroid diseases, absence of nodular goiter had a higher rate of central lymph node metastasis(P=0.018, 0.001, 0.004). (4) Those cases with a negative result of lateral cervical lymph nodes examination whom in the group of central lymph node metastasis had a higher rate of lateral lymph node metastasis than the group of absence of central lymph node metastasis(P=0.027). Conclusions: There were certain associations between the central lymph nodes metastasis, lateral lymph node metastasis and clinicopathological features in thyroid papillary carcinoma patients. This is of important significance for clinical treatment choice.