Metastatic Trend Of Lymph Nodes In Neck And The Choice Of Surgical Treatment Of Papillary Thyroid Carcinoma

Objective:PTC is a well-differentiated malignant tumor, it usually metastases through the cervical lymph node. Most scholars consider that VI district is the sentinel lymph node of PTC and with a higher transfer rate, they advocate even if the clinical examination is cN0, also should do dissections both the primary focal and VI district lymph node in the first surgery, but have controversy over preventative cervical lymph node dissections, and not reached an agreement for the dissection scope of positive clinical cervical lymph node, Currently recommend do the functional lateral cervical lymph node dissections. This article focuses on metastatic trend of lymph nodes in neck and the choice of surgical treatment of papillary thyroid carcinoma.Methods:All patients from January 2010 to January 2011 in our hospital were collected,777 cases of surgical treatment of PTC were analyzed retrospectively. In 386 cases of PTMC,363 cases receiving modified radical neck dissection, in which 113 cases only received VI district modified radical neck dissection,210 cases received VI district and unilateral cervical lymph nodes dissection,26 cases received VI district and bilateral cervical lymph nodes dissection,9 cases only received unilateral cervical lymph node dissection,5 cases received bilateral cervical lymph node dissection; In 391 cases of PTC, all the cases receiving modified radical neck dissection, in which 18 cases only received VI district modified radical neck dissection,262 cases received VI district and unilateral cervical lymph nodes dissection,101 cases received VI district and bilateral cervical lymph nodes dissection,9 cases only received unilateral cervical lymph node dissection,1 cases received bilateral cervical lymph node dissection. Result:In 386 cases of PTMC,363 cases receiving modified radical neck dissection, in which 113 cases only receivedâ…¥district modified radical neck dissection,46 cases had lymph node metastasis; 14 cases only received lateral cervical lymph node dissection,6 cases had lymph node metastasis; 236 cases receivedâ…¥district and lateral cervical lymph nodes dissection, in which 54 patients showed all had metastasis,34 cases onlyâ…¥district had metastasis, and 13 cases only occurred lateral cervical metastasis. In 391 cases of PTC, all cases receiving modified radical neck dissection, in which 18 cases only receivedâ…¥district modified radical neck dissection,6 cases had lymph node metastasis; 10 cases received lateral cervical lymph node dissection,6 cases had lymph node metastasis; 363 cases receivedâ…¥district and lateral cervical lymph nodes dissection, in which 161 patients showed all had metastasis,61 cases onlyâ…¥district had metastasis, and 32 cases only occurred lateral cervical metastasis.349 cases of PTMC receivingâ…¥district modified radical neck dissection,134 cases had lymph node metastasis, lymph node metastasis was 38.40%(134/349); 250 cases received lateral cervical lymph node dissection,73 cases had lymph node metastasis, lymph node metastasis was 29.20%(73/250); the transfer region mainly inâ…¡,â…¢,â…£district.381 cases of PTC receivingâ…¥district modified radical neck dissection,229 cases had lymph node metastasis, lymph node metastasis was 60.10% (229/381); 373 cases only received lateral cervical lymph node dissection,199 cases had lymph node metastasis, lymph node metastasis was 53.35% (199/373); the transfer region mainly inâ…¡,â…¢,â…£area. All patients underwent preoperative ultrasonography examination,442 cases were diagnosed by ultrasonography suspected cancer,397 cases were envidenced by postoperative pathologic, ultrasound diagnostic accuracy rate was 89.82%, sensitivity was 94.52%, specific degrees rate was 86.53%.Conclution:1. In PTC, districtâ…¥has a higher lymph node metastasis, and has a hidden transfer rate, we suggest whatever size of the tumer, should do dissections both the primary focal and VI district lymph node in the first surgery.2. For the lateral neck area, PTMC if such as the lymph nodes has no doubt before surgery, you do not need prophylactic lateral neck dissection; because of PTC patients have a high lymph node metastasis, even preoperative clinical examination did not see the lateral cervical lymph node metastases, we also recommend preventive lateral cervical lymph node dissection:districtâ…¡â…¢,â…£; district I has rarely transfered, not as the regular dissection; for district V, if such as the lymph nodes has no doubt before surgery, you should not need prophylactic lateral neck dissection.3. There is a correlation between the metastases of district VI and lateral cervical lymph node, we can use the metastases of district VI as a element of predicting lateral cervical lymph node metastases.4. Ultrasound is a sensitive and inexpensive method to check cervical lymph nodes, if preoperative ultrasonography doubt cervical lymph node has metastasis, we should do the cervical lymph node dissection, Ultrasound examination has guiding significance in the choice of cervical lymph node dissection.