Correlative factors of lymph node metastasis and surgical method of papillary thyroid microcarcinoma / 国际外科学杂志

ABSTRACT

Objective To analyze the correlation between the primary lesion of papillary thyroid microcarcinoma (PTMC) and the metastasis of cervical lymph node,explore the surgical method of PTMC.Methods From Jan.2013 to Nov.2016 in Beijing Friendship Hospital,Capital Medical University,there were 545 cases of PTMC treated with surgery,induded 432 females and 113 males (3.82 to 1),aged 14 to 80 years old (average 46.7 ±11.8 years).Surgical methods:the percent of total or near total resection was 70.6％ (385/545),lobectomy and isthmectomy was 29.4％ (160/545).There were 524 cases of lymph node dissection in the central region of the neck,of which 78.3％ (427/524) were unilateral swept,and 17.8％ (97/524) were swept on both sides.There were 14 cases of lymph node dissection in the neck area.There were 930 thyroid lobe specimens,622 lymph node specimens in central neck region and 14 lymph node specimens in lateral neck region.In this study,576 specimens of thyroid gland and the same side cervical lymph nodes were selected.The diameter was (0.58 ± 0.25) cm.There were 513 single lesion cases (89.1％) and 63 multiple lesion cases (10.9％).There were 441 cases (76.6％) without extrathyroid invasion and 135 cases (23.4％) with extrathyroid invasion.The number of cervical central area lymph nodes was 4.7 ± 3.8.The transfer rate of cervical central area lymph nodes was 31.8％.The number of cervical lateral area lymph nodes was 17.8 ± 10.0.The transfer rate of cervical lateral area lymph nodes was 2.4％.SPSS 19.0 statistical software was used.for statistical processing,and the standard deviation of the measurement data was expressed as the standard deviation.The counting data was expressed as a percentage,and the chi-square test was used for the comparison between groups.The single factor correlation was analyzed by Pearson.The statistical methods included independent sample t test,Pearson correlation analysis and x2 test.Results There was high positive correlation between diameter of PTMC and transfer rate of cervical central area lymph nodes (r =0.847).The transfer rate of cervical central area lymph nodes was significantly increased when focus diameter was greater than 0.8 cm.There was significant positive correlation between diameter of PTMC and transfer rate of cervical lateral area lymph nodes(r =O.557).The transfer rate of cervical lateral area lymph nodes was significantly increased when focus diameter was greater than 0.9 cm.The transfer rate of cervical central and lateral area lymph nodes to multi focus cases were similar to single focus cases.The transfer rate of cervical central and lateral area lymph nodes to thyroid capsule invaded cases were higher than thyroid capsule non-invaded cases.Conclusions The focus diameter and capsule invasion of PTMC were related to cervical lymph node metastasis.The number of cancer lesions is not related to cervical lymph node metastasis.As early as possible,surgical operation can lead to timely treatment of many PTMC cases,of which cervical lymph node metastasis has occurred,but preoperative diagnosis can not be obtained.Surgical methods of initial treatment were total/near total thyroidectomy or thyroid lobectomy plus unilateral/bilateral cervical central area lymph node dissection and/or add to cervical lateral area lymph node dissection.