| Objective: In the last 15 years,trend incidence of papillary thyroid cancer(PTC)was increasing in several epidemiological studies around the world.The increase was mainly due to thyroid microcarcinoma(TMC),while the incidence of larger tumors was no change.Thyroid microcarcinoma had been defined as thyriod cancer ?1.0cm in diameter,no matter if it has metastasis or not.Since almost all the tumors are of papillary histotype,the preferred definition is now Micro-Papillary Thyroid Carcinoma(mPTC).Although mostly indolent in its growth,it appears that a subgroup of mPTCs may have an aggressive biological behavior similar to that of clinical PTC.The aggressive behavior is associated with prevalence of lymph node metastases.The cervical lymph nodes metastases usually present in ??????? regions.The morbidity of mPTC is increasing,while the mortality is not increasing.We aim to minimize the frequency of recurrence and metastasis without affecting the therapeutic effectiveness and excellent quality of life.The patients who have diagnosed cervical lymph nodes metastases should perform neck dissenction.While the cases are not diagnosed should also perform neck dissenction or not,this is controversial.This study we investigated aimed to benefit for the operation decision in mPTC treatment.Method: 75 cases with mPTC from patients who were performed operation in our department from October 2014 to December 2015 were included in this study.1 Inclusion and exclusion criteria1.1 Inclusion criteria:(1)thyriod cancer ?1.0cm in diameter;(2)the tumors are of papillary histotype;1.2 Exclusion criteria:(1)recurrent cases;(2)history of radiotherapy and chemotherapy;(3)diagnosed post-surgery at final histology and did not perform neck dissenction or second operation;(4)history of radiation exposure;(5)familial thyriod cancer;(6)history of radioiodine ablation.All cases performed surgery and diagnosed post-surgery.The sections diagnosed by two above pathologists.Neck ultrasound thyroid hormone and parathyroid hormone measurement were done pre-surgery.61 cases were diagnosed by frozen sections.63 cases performed central neck dissection,12 cases performed central neck dissection and lateral neck dissection.2 All data were collected for statistical analysis with the SPSS 13.0.?2 test was used for a clinical factor and Logistic regression analysis was used for multiple clinical factors(?entry=0.05,?removal=0.10).P?0.05 as the difference was statistically significant.Results:1 In the 75 cases there were 29 patients were found with lymph node metastasis,among them central and lateral cervical lymph node metastases was 38.7% and 12.0%,respectively(29 cases and 9 cases).2 The tumor diamater less than 0.8cm and greater than 0.8cm the central lymph node metastasis rate was 30.8% and 56.5%,respectively.There was significant difference in the metastasis rates of them in univariate analysis(P=0.035).The single and mutiple lesions the central lymph node metastasis rate was 30.8% and 56.5%,respectively.There was significant difference in the metastasis rates of them in univariate analysis(P=0.035).The single and mutiple lesions the lateral lymph node metastasis rate was 5.8% and 26.1%,respectively.There was significant difference in the metastasis rates of them in univariate analysis(P=0.035).The multivariate linear regression analysis showed that the size and number of tumors were independent factors in the metastasis rates of central lymph node.The number of tumors were independent factor in the metastasis rates of lateral lymph node.Conclusions:1 The presence of increased tumor size and multifocal were independent factors for predicting central lymph node metastasis.The presence of multifocal was independent factor for predicting lateral lymph node metastasis.2 The primary therapeutic method for mPTC was surgery.The mPTC had a high tendence of metastasis.And we proposed prophylactic central neck dissection.The patients who were suspected but not diagnosed with lateral lymph nodes metastases,it is significant to perform selective neck dissection in tumors with multifocal. |
PDF Full Text Request