侧颈探查在淋巴结细针穿刺阴性甲状腺乳头状癌中的临床价值
The clinical value of lateral neck exploration in papillary thyroid carcinoma with negative result of lymph nodes fine-needle aspiration
王艺微 1李旺 1王圣应2
作者信息
- 1. 安徽省肿瘤医院甲状腺外科,合肥 230001
- 2. 安徽中医药大学第一附属医院甲状腺乳腺外科,合肥 230001
- 折叠
摘要
目的 探讨术中侧颈探查在侧颈淋巴结(LLNs)细针穿刺细胞学(FNAC)诊断阴性的甲状腺乳头状癌(PTC)中的临床价值.方法 前瞻性纳入2022年1月至2023年12月在安徽省肿瘤医院初诊的术前超声评估LLNs可疑而FNAC阴性的100例PTC患者,在根治性手术中行侧颈探查,根据术中冰冻病理结果决定侧颈淋巴结清扫(LLND)范围.结果 100例患者中,经术中冰冻病理证实侧颈淋巴结转移(LLNM)62例,行LLND共62例;经术后常规病理证实LLNM共69例.相比于侧颈无转移组,多灶性PTC更易发生LLNM(RR=1.493,x2=8.911,P=0.003),LLNM组的主病灶更大[(15.96±9.62)mm 比(12.55±4.79)mm,t=-2.362,P=0.020]、中央区淋巴结转移率更高[(43.59％±27.02％)比(23.83％±26.24％),t=-3.411,P=0.001].LLNM组的LLNs在超声上显示更多的典型特征,如局限性/不均匀性皮质增厚、皮质内点条状/团块状高回声区、无回声区,边缘型/混合型血流.FNAC和术中冰冻病理检查结果的准确率分别为87.61％、93.00％,漏诊率分别为13.12％、10.14％.结论 对术前超声评估LLNs可疑而FNAC阴性的PTC,通过术中侧颈探查可提高LLNM诊断率,减少PTC-LLNM的漏诊与漏治.
Abstract
Objective To investigate the clinical value of intraoperative lateral neck exploration in papillary thyroid carcinoma(PTC)patients with negative result of fine-needle aspiration cytology(FNAC)on suspected lateral cervical lymph nodes(LLNs).Methods From Jan 2022 to Dec 2023,a total of 100 PTC patients with ultrasound-suspected metastatic LLNs while FNAC were negative were prospectively enrolled.Lateral neck exploration was performed during radical surgery,and the range of lateral cervical lymph node dissection(LLND)was determined according to the intraoperative frozen pathological results.Results Among the 100 patients,62 cases of lateral cervical lymph node metastasis(LLNM)were confirmed by intraoperative frozen pathology,and 62 cases of LLND were performed.A total of 69 cases of LLNM were confirmed by postoperative routine pathology.Compared with the non-LLNM group,multifocal PTC was more likely to have LLNM(RR=1.493,x2=8.911,P=0.003).The main lesion of the LLNM group was larger[(15.96±9.62)mm vs.(12.55±4.79)mm,t=-2.362,P=0.020],and the central lymph node metastasis rate was higher[(43.59％±27.02％)vs.(23.83％±26.24％),t=-3.411,P=0.001].The LLNs in the LLNM group showed more typical characteristics on ultrasound,such as localized inhomogeneous cortical thickening,cortical strip mass hyperechoic area,echoless area,and marginal or mixed blood flow.The accuracy rates of FNAC and intraoperative frozen pathology were 87.61％and 93.00％,respectively,and the missed diagnosis rates were 13.12％and 10.14％,respectively.Conclusions In PTC with ultrasound-suspected metastatic LLNs while FNAC were negative,intraoperative lateral neck exploration can improve the diagnosis rate of LLNM and reduce the missed diagnosis of LLNM.
关键词
乳头状甲状腺癌/穿刺术/淋巴转移Key words
Thyroid cancer,papillary/Punctures/Lymphatic metastasis引用本文复制引用
出版年
2024
NETL
NSTL
万方数据