Early Warning Significance Of Jugulo-omohyoid Lymph Nodes To Lymph Node Metastasis In The Posterior Jugular Vein Of Papillary Thyroid Carcinoma

Objective:In order to investigate the early warning effect of jugulo-omohyoid lymph nodes(JOHLN)on lateral cervical lymph nodes metastasis behind internal jugular vein in patients with papillary thyroid carcinoma(PTC)and its clinical significance.Methods:We make a retrospective analysis of the clinicopathological data of 220 patients diagnosed as PTC with high risk of lateral cervical lymph nodes metastasis treated by the same professor team of Department of Thyroid Surgery in the First Hospital of Jilin University from June 2010 to June 2019.All these patients underwent Thyroid Cancer Radical Surgery and multifunctional retention cervical lymph node dissection.The samples labeled as JOHLN were sent to pathological examination.The resected specimens were examined by paraffin-embedded pathology.Making analysis of the early warning effect of JOHLN on lymph node metastasis in the posterior cervical jugular vein of PTC and its clinical significance.Results:(1)Among the 220 patients,pN1b was not associated with gender,age,Hashimoto,invasion of the capsule,and whether the tumor diameter is less than or equal to 1 cm or greater than 1 cm,but was associated with central lymph node metastasis and tumor location.(2)JOHLN metastasis correlates with tumor location.No correlation between lateral cervical lymph nodes metastasis behind internal jugular vein and tumor location.(3)The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of JOHLN for predicting lymph node metastasis in the posterior jugular vein group were 83.5%,46.4%,82.0%,49.1%,and 74.1%,respectively.(4)When the tumor is located in the upper part of thyroid,the sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of JOHLN for predicting lymph node metastasis in the posterior jugular vein group are 86.3%,66.7%,95.8%,35.3%,and 84.3%,respectively.(5)Correlation between JOHLN metastasis and tumor diameter in upper tumor.There was no correlation between lymph node metastasis in the posterior jugular vein group of the upper tumor and tumor diameter.(6)There were 11 patients with negative lymph nodes in the central region and metastasis of the lateral neck lymph nodes,accounting for 5.67%(11/194)of lateral neck lymph node metastases,including 9 patients with upper tumors and 2 patients with middle tumors.There were JOHLN metastases in all 11 cases,and 6 cases had lateral cervical lymph nodes metastasis behind internal jugular vein.Conclusions:(1)JOHLN can effectively predict the risk of PTC lateral neck metastasis in the upper and middle thyroid which has a certain early warning effect on lateral cervical lymph nodes.Upper tumors,due attention should be paid to JOHLN.(2)For difficult to evaluate areas behind the vein,preoperative or intraoperative JOHLN biopsy,combined with other known high-risk factors for lateral neck metastasis,such as central lymph node metastasis or tissue invasion,can help to decide lateral cervical lymph node dissection,which is expected to reduce reoperation and avoid overtreatment of the lateral neck.(3)When the tumor is located in the upper part of the thyroid,JOHLN may be a preferential channel for papillary cancer cells to metastasize to lateral cervical lymph nodes.JOHLN may be the theoretical basis for jumping metastases in middle and upper tumors.