| Objective:Papillary thyroid carcinoma is easy to cause cervical lymph node metastasis.When lymph node metastasis is found after operation,reoperation is more difficult,which may be accompanied by a variety of complications.Therefore,it has great clinical meaning to analyze and evaluate the factors related to lateral cervical lymph node metastasis before operation.By studying these clinical characteristics of lateral cervical lymph node metastasis of papillary thyroid cancer,strengthen the comprehension of related factors of lateral cervical lymph node metastasis,evaluate the individual characteristics and related risk factors of patients in detail and accurately,clarify the indications and scope of neck lymph node dissection,and make clinical evaluation and analysis of ultrasound examination,which is indispensable for the diagnosis of thyroid cancer,so as to further optimize the clinical treatment to provide reference for the individualized and scientific diagnosis and treatment of bed patients.Method:A retrospective analysis was conducted in Department of thyroid and breast surgery,Xinmin Campus,China-Japan Union Hospital of Jilin University from August 2018 to December 2020,the clinical data of 127 PTC patients who met the inclusion criteria in the same treatment group were retrospectively analyzed.All patients underwent radical thyroidectomy(standard operation plan)+ lateral neck lymph node dissection(zone II,zone III,Zone IV);the clinical data of 127 patients with PTC were statistically analyzed,including age,gender,tumor size,tumor location,tumor number,dorsal membrane invasion or extraglandular invasion,chronic lymphocytic thyroiditis,and central lymph node metastasis.At the same time,according to the postoperative paraffin pathological results,the number of cases of lymph node metastasis in each region of the lateral neck was counted and compared with the number of cases of lymph node metastasis in each region of the lateral neck suspected by preoperative ultrasound,and the effect of preoperative ultrasound diagnosis was evaluated.Results:The metastatic rate of cervical lymph nodes was 63.8%(81 / 127).There were 39 male patients,accounting for 30.7%(39 / 127),and the ratio of male to female was1:2.26;70 cases were younger than 45 years old,57 cases were older than 45 years old,aged from 28 to 67 years old,the median age was 46 years old;73 cases(57.5%)had tumors larger than 1 cm;There were 59 cases(46.5%)with multiple foci,47 cases(37.0%)with invasion of thyroid dorsal membrane or extraglandular infiltration,62 cases(48.8%)with chronic lymphocytic thyroiditis,102 cases(80.3%)with central lymph node metastasis;In the observation group,49 cases were younger than 45 years old,29 cases were male,62 cases were tumor diameter ≥ 1 cm,49 cases were multifocal,38 cases were invasion of dorsal membrane or extraglandular infiltration,32 cases were accompanied by chronic lymphocytic thyroiditis,76 cases were central lymph node metastasis,and 5 cases were skip lymph node metastasis.Among the lateral cervical lymph node metastasis,68 cases were found in Zone III,followed by 53 cases in Zone IV and 35 cases in zone II,accounting for27.6%;9 cases were found in zone II + III + IV,27 cases in Zone III + IV and 15 cases in zone II + III;among the 35 cases in zone II,35 cases were found in zone IIA,and only 3 cases were found with zone IIB metastasis.Among the 35 patients with zone II lymph node metastasis,28 cases were situated in the upper part of the gland,68 cases in Zone III lymph node metastasis,48 cases in the upper section of the gland,and 21 cases in Zone IV lymph node metastasis.There were 36 cases,68 cases and 58 cases of lymph node metastasis in area II,III and IV by preoperative ultrasound.Univariate chi square test showed that there was no interrelationship between age and lymph node metastasis in lateral cervical region II,III and IV(P >0.01);Gender,the largest diameter of cancer focus,the number of cancer focus,chronic lymphocytic thyroiditis,the occurrence of central lymph node metastasis were correlated with lateral cervical lymph node metastasis in II,III,IV areas(P <0.01);The location of the tumor in the upper section of the thyroid gland was significantly correlated with lymph node metastasis in area II(P < 0.01);Multivariate logistic regression analysis showed that tumor diameter(or = 7.527,95% CI1.454-38.961,P = 0.016)and central lymph node metastasis(or = 6.101,95% CI1.662-22.405,P = 0.006)were independent risk factors for lateral cervical lymph node metastasis in papillary thyroid carcinoma.The sensitivity,specificity and accuracy of preoperative ultrasound evaluation for metastatic lymph nodes in zone II were 91.4%,91.8% and 95.1%,respectively;the sensitivity,specificity and accuracy of preoperative ultrasound evaluation for metastatic lymph nodes in Zone III were86.8%,59.1% and 88.9%,respectively;the sensitivity,specificity and accuracy of preoperative ultrasound evaluation for metastatic lymph nodes in Zone IV were84.9%,63.8% and 84.0%,respectively.Conclusion:The incidence of lateral cervical lymph node metastasis in papillary thyroid carcinoma was high;The larger the tumor diameter and the involvement of central lymph nodes were the independent risk factors of lymph node metastasis in lateral cervical region II,III and IV;The tumor was located in the upper part of thyroid gland,which was associated with lymph node metastasis in lateral cervical region II of papillary thyroid carcinoma;Ultrasound evaluation plays an irreplaceable role in lateral cervical lymph node metastasis,which can be combined with other diagnostic methods to improve the diagnostic rate. |
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