Value of pretracheal lymph node subdivision in predicting contralateral central lymph node metastasis for cN0 unilateral papillary thyroid carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Pei ¹ , LU Wei ¹ , SONG Linlin ¹ , CHEN Qiang ² , SU Anping ² , LIU Feng ² ,  ZHU Jingqiang ²

1. West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

ZHU Jingqiang, Email: zjq-wkys@163.com

Keywords：

papillary thyroid carcinoma; clinical lymph node negative; pretracheal lymph node; prelaryngeal lymph node; central lymph node dissection

DOI：

10.7507/1007-9424.202202025

Video：

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Objective To investigate the predictive value of pretracheal lymph node (Ⅵc) subdivision for contralateral central lymph node (CLN) metastasis in clinical lymph node negative (cN0) unilateral papillary thyroid carcinoma (PTC). Methods The data of patients with cN0 unilateral PTC who initially underwent total thyroidectomy and bilateral CLN dissection in the Department of Thyroid Surgery of West China Hospital, Sichuan University from July 2017 to June 2021 were collected retrospectively. The Ⅵc subdivision was divided into right anterior trachea (Ⅵc1) and left anterior trachea (Ⅵc2); If the lymph nodes crossed the middle line of trachea, which would be included in the side of cancer focus. Results A total of 175 patients were included in this study, and the incidences of lymph nodes metastasis in the prelaryngeal (Ⅵd), Ⅵc, ipsilateral Ⅵc, contralateral Ⅵc, ipsilateral central, and contralateral central regions were 54 cases (30.9%), 118 cases (67.4%), 85 cases (48.6%), 72 cases (41.1%), 108 cases (61.7%), and 43 cases (24.6%), respectively. The results of the univariate analysis found that the contralateral CLN metastasis was associated with the lymph node metastases of Ⅵd, Ⅵc, contralateral Ⅵc, and ipsilateral central regions; The results of the multivariate analysis found that the lymph node metastases of Ⅵd and contralateral Ⅵc regions increased the probability of contralateral CLN metastasis (OR=4.444, P<0.001; OR=6.655, P=0.001). Conclusions From the results of the study,Ⅵc subdivision is reasonable and effective, and has a certain predictive value for the metastasis of contralateral CLN in cN0 unilateral papillary thyroid carcinoma. And bilateral CLN dissection should be recommended in patients with a positive intraoperative frozen section result of contralateral pretracheal lymph node metastasis.

Citation： ZHANG Pei, LU Wei, SONG Linlin, CHEN Qiang, SU Anping, LIU Feng, ZHU Jingqiang. Value of pretracheal lymph node subdivision in predicting contralateral central lymph node metastasis for cN0 unilateral papillary thyroid carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(10): 1339-1343. doi: 10.7507/1007-9424.202202025 Copy

1.	赫捷, 李進, 程穎, 等. 中國臨床腫瘤學會(CSCO)分化型甲狀腺癌診療指南2021. 腫瘤預防與治療, 2021, 34(12): 1164-1201.
2.	彭琛, 魏松鋒, 鄭向前, 等. 1 401例甲狀腺微小乳頭狀癌臨床病理特征及中央區淋巴結轉移危險因素分析. 中國腫瘤臨床, 2016, 43(3): 95-99.
3.	Seo JW, Han K, Lee J, et al. Application of metabolomics in prediction of lymph node metastasis in papillary thyroid carcinoma. PLoS One, 2018, 13(3): e0193883. doi: 10.1371/journal.pone.0193883.
4.	Lee JH, Shin JH, Lee HW, et al. Sonographic and cytopathologic correlation of papillary thyroid carcinoma variants. J Ultrasound Med, 2015, 34(1): 1-15.
5.	Maksimovic S, Jakovljevic B, Gojkovic Z. Lymph node metastases papillary thyroid carcinoma and their importance in recurrence of disease. Med Arch, 2018, 72(2): 108-111.
6.	Shah JP. Exploiting biology in selecting treatment for differentiated cancer of the thyroid gland. Eur Arch Otorhinolaryngol, 2008, 265(10): 1155-1160.
7.	Chen Q, Wei T, Wang XL, et al. The total number of prelaryngeal and pretracheal lymph node metastases: is it a reliable predictor of contralateral central lymph node metastasis in papillary thyroid carcinoma? J Surg Res, 2017, 214: 162-167.
8.	Kim WW, Park HY, Jung JH. Surgical extent of central lymph node dissection in clinically node-negative papillary thyroid cancer. Head Neck, 2013, 35(11): 1616-1620.
9.	Sakorafas GH, Sampanis D, Safioleas M. Cervical lymph node dissection in papillary thyroid cancer: current trends, persisting controversies, and unclarified uncertainties. Surg Oncol, 2010, 19(2): e57-e70. doi: 10.1016/j.suronc.2009.04.002.
10.	Wada N, Duh QY, Sugino K, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg, 2003, 237(3): 399-407.
11.	Oltmann SC, Schneider DF, Chen H, et al. All thyroid ultrasound evaluations are not equal: sonographers specialized in thyroid cancer correctly label clinical N0 disease in well differentiated thyroid cancer. Ann Surg Oncol, 2015, 22(2): 422-428.
12.	朱精強. 分化型甲狀腺癌頸淋巴結清掃的相關問題. 中國普外基礎與臨床雜志, 2012, 19(8): 809-813.
13.	朱精強, 雷建勇, 姜可. 甲狀腺微小乳頭狀癌淋巴結轉移特點及處理策略. 中國普外基礎與臨床雜志, 2016, 23(10): 1160-1165.
14.	蘇安平, 邢志超, 朱精強. 甲狀腺術后甲狀旁腺功能低下的定義及意義. 中國普外基礎與臨床雜志, 2019, 26(10): 1157-1161.
15.	Mulla M, Schulte KM. The accuracy of ultrasonography in the preoperative diagnosis of cervical lymph node (LN) metastasis in patients with papillary thyroid carcinoma: a meta-analysis. Eur J Radiol, 2012, 81(8): 1965. doi: 10.1016/j.ejrad.2012.01.015.
16.	Suh CH, Baek JH, Choi YJ, et al. Performance of CT in the preoperative diagnosis of cervical lymph node metastasis in patients with papillary thyroid cancer: a systematic review and meta-analysis. AJNR Am J Neuroradiol, 2017, 38(1): 154-161.
17.	Gross ND, Weissman JL, Talbot JM, et al. MRI detection of cervical metastasis from differentiated thyroid carcinoma. Laryngoscope, 2001, 111(11 Pt 1): 1905-1909.
18.	Chen QH, Raghavan P, Mukherjee S, et al. Accuracy of MRI for the diagnosis of metastatic cervical lymphadenopathy in patients with thyroid cancer. La Radiol Med, 2015, 120(10): 959-966.
19.	Hwang HS, Orloff LA. Efficacy of preoperative neck ultrasound in the detection of cervical lymph node metastasis from thyroid cancer. Laryngoscope, 2011, 121(3): 487-491.
20.	熊建霞. 單側甲狀腺乳頭狀癌對側中央區淋巴結轉移的相關危險因素研究分析. 太原: 山西醫科大學, 2020.
21.	丁金旺, 彭友, 張臥, 等. 單側甲狀腺乳頭狀癌對側中央區淋巴結轉移的臨床危險因素分析. 中國耳鼻咽喉頭頸外科, 2018, 25(8): 406-410.
22.	潘燁, 鄭起. 甲狀腺全切聯合中央區淋巴結清掃術安全性的Meta分析. 中華內分泌外科雜志, 2010, 4(6): 379-382.
23.	胡治華, 華清泉. 分化型甲狀腺癌cN0期Ⅵ區淋巴結清掃必要性的系統評價. 中國醫藥導報, 2014, 11(9): 80-85.
24.	Henry JF, Gramatica L, Denizot A, et al. Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbecks Arch Surg, 1998, 383(2): 167-169.
25.	Giordano D, Valcavi R, Thompson GB, et al. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1 087 patients and review of the literature. Thyroid, 2012, 22(9): 911-917.
26.	林佳偉, 林炘, 楊熙鴻. 甲狀腺癌手術喉返神經損傷的影響因素分析及預防. 中國耳鼻咽喉顱底外科雜志, 2021, 27(6): 702-705.
27.	李新營, 王志明, 呂新生, 等. 甲狀腺疾病再次手術的原因及并發癥分析. 中國普通外科雜志, 2005, 14(9): 644-647.
28.	朱精強, 蘇安平, 王明俊. 《甲狀腺圍手術期甲狀旁腺功能保護指南(2018版)》解讀. 中國普外基礎與臨床雜志, 2019, 26(10): 1145-1148.
29.	Iyer NG, Kumar A, Nixon IJ, et al. Incidence and significance of Delphian node metastasis in papillary thyroid cancer. Ann Surg, 2011, 253(5): 988-991.
30.	高慶軍, 王南鵬, 周彥, 等. 甲狀腺乳頭狀癌頸部淋巴結轉移規律及影響因素分析. 中國普外基礎與臨床雜志, 2013, 20(3): 303-309.
31.	Oh EM, Chung YS, Lee YD. Clinical significance of Delphian lymph node metastasis in papillary thyroid carcinoma. World J Surg, 2013, 37(11): 2594-2599.
32.	Isaacs JD, McMullen TP, Sidhu SB, et al. Predictive value of the Delphian and level Ⅵ nodes in papillary thyroid cancer. ANZ J Surg, 2010, 80(11): 834-838.
33.	何偉, 蘇新良, 吳凱南, 等. cN0甲狀腺乳頭狀癌對側中央區淋巴結轉移相關因素的探討. 中國腫瘤臨床, 2017, 44(1): 41-45.

1. 赫捷, 李進, 程穎, 等. 中國臨床腫瘤學會(CSCO)分化型甲狀腺癌診療指南2021. 腫瘤預防與治療, 2021, 34(12): 1164-1201.
2. 彭琛, 魏松鋒, 鄭向前, 等. 1 401例甲狀腺微小乳頭狀癌臨床病理特征及中央區淋巴結轉移危險因素分析. 中國腫瘤臨床, 2016, 43(3): 95-99.
3. Seo JW, Han K, Lee J, et al. Application of metabolomics in prediction of lymph node metastasis in papillary thyroid carcinoma. PLoS One, 2018, 13(3): e0193883. doi: 10.1371/journal.pone.0193883.
4. Lee JH, Shin JH, Lee HW, et al. Sonographic and cytopathologic correlation of papillary thyroid carcinoma variants. J Ultrasound Med, 2015, 34(1): 1-15.
5. Maksimovic S, Jakovljevic B, Gojkovic Z. Lymph node metastases papillary thyroid carcinoma and their importance in recurrence of disease. Med Arch, 2018, 72(2): 108-111.
6. Shah JP. Exploiting biology in selecting treatment for differentiated cancer of the thyroid gland. Eur Arch Otorhinolaryngol, 2008, 265(10): 1155-1160.
7. Chen Q, Wei T, Wang XL, et al. The total number of prelaryngeal and pretracheal lymph node metastases: is it a reliable predictor of contralateral central lymph node metastasis in papillary thyroid carcinoma? J Surg Res, 2017, 214: 162-167.
8. Kim WW, Park HY, Jung JH. Surgical extent of central lymph node dissection in clinically node-negative papillary thyroid cancer. Head Neck, 2013, 35(11): 1616-1620.
9. Sakorafas GH, Sampanis D, Safioleas M. Cervical lymph node dissection in papillary thyroid cancer: current trends, persisting controversies, and unclarified uncertainties. Surg Oncol, 2010, 19(2): e57-e70. doi: 10.1016/j.suronc.2009.04.002.
10. Wada N, Duh QY, Sugino K, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg, 2003, 237(3): 399-407.
11. Oltmann SC, Schneider DF, Chen H, et al. All thyroid ultrasound evaluations are not equal: sonographers specialized in thyroid cancer correctly label clinical N0 disease in well differentiated thyroid cancer. Ann Surg Oncol, 2015, 22(2): 422-428.
12. 朱精強. 分化型甲狀腺癌頸淋巴結清掃的相關問題. 中國普外基礎與臨床雜志, 2012, 19(8): 809-813.
13. 朱精強, 雷建勇, 姜可. 甲狀腺微小乳頭狀癌淋巴結轉移特點及處理策略. 中國普外基礎與臨床雜志, 2016, 23(10): 1160-1165.
14. 蘇安平, 邢志超, 朱精強. 甲狀腺術后甲狀旁腺功能低下的定義及意義. 中國普外基礎與臨床雜志, 2019, 26(10): 1157-1161.
15. Mulla M, Schulte KM. The accuracy of ultrasonography in the preoperative diagnosis of cervical lymph node (LN) metastasis in patients with papillary thyroid carcinoma: a meta-analysis. Eur J Radiol, 2012, 81(8): 1965. doi: 10.1016/j.ejrad.2012.01.015.
16. Suh CH, Baek JH, Choi YJ, et al. Performance of CT in the preoperative diagnosis of cervical lymph node metastasis in patients with papillary thyroid cancer: a systematic review and meta-analysis. AJNR Am J Neuroradiol, 2017, 38(1): 154-161.
17. Gross ND, Weissman JL, Talbot JM, et al. MRI detection of cervical metastasis from differentiated thyroid carcinoma. Laryngoscope, 2001, 111(11 Pt 1): 1905-1909.
18. Chen QH, Raghavan P, Mukherjee S, et al. Accuracy of MRI for the diagnosis of metastatic cervical lymphadenopathy in patients with thyroid cancer. La Radiol Med, 2015, 120(10): 959-966.
19. Hwang HS, Orloff LA. Efficacy of preoperative neck ultrasound in the detection of cervical lymph node metastasis from thyroid cancer. Laryngoscope, 2011, 121(3): 487-491.
20. 熊建霞. 單側甲狀腺乳頭狀癌對側中央區淋巴結轉移的相關危險因素研究分析. 太原: 山西醫科大學, 2020.
21. 丁金旺, 彭友, 張臥, 等. 單側甲狀腺乳頭狀癌對側中央區淋巴結轉移的臨床危險因素分析. 中國耳鼻咽喉頭頸外科, 2018, 25(8): 406-410.
22. 潘燁, 鄭起. 甲狀腺全切聯合中央區淋巴結清掃術安全性的Meta分析. 中華內分泌外科雜志, 2010, 4(6): 379-382.
23. 胡治華, 華清泉. 分化型甲狀腺癌cN0期Ⅵ區淋巴結清掃必要性的系統評價. 中國醫藥導報, 2014, 11(9): 80-85.
24. Henry JF, Gramatica L, Denizot A, et al. Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbecks Arch Surg, 1998, 383(2): 167-169.
25. Giordano D, Valcavi R, Thompson GB, et al. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1 087 patients and review of the literature. Thyroid, 2012, 22(9): 911-917.
26. 林佳偉, 林炘, 楊熙鴻. 甲狀腺癌手術喉返神經損傷的影響因素分析及預防. 中國耳鼻咽喉顱底外科雜志, 2021, 27(6): 702-705.
27. 李新營, 王志明, 呂新生, 等. 甲狀腺疾病再次手術的原因及并發癥分析. 中國普通外科雜志, 2005, 14(9): 644-647.
28. 朱精強, 蘇安平, 王明俊. 《甲狀腺圍手術期甲狀旁腺功能保護指南(2018版)》解讀. 中國普外基礎與臨床雜志, 2019, 26(10): 1145-1148.
29. Iyer NG, Kumar A, Nixon IJ, et al. Incidence and significance of Delphian node metastasis in papillary thyroid cancer. Ann Surg, 2011, 253(5): 988-991.
30. 高慶軍, 王南鵬, 周彥, 等. 甲狀腺乳頭狀癌頸部淋巴結轉移規律及影響因素分析. 中國普外基礎與臨床雜志, 2013, 20(3): 303-309.
31. Oh EM, Chung YS, Lee YD. Clinical significance of Delphian lymph node metastasis in papillary thyroid carcinoma. World J Surg, 2013, 37(11): 2594-2599.
32. Isaacs JD, McMullen TP, Sidhu SB, et al. Predictive value of the Delphian and level Ⅵ nodes in papillary thyroid cancer. ANZ J Surg, 2010, 80(11): 834-838.
33. 何偉, 蘇新良, 吳凱南, 等. cN0甲狀腺乳頭狀癌對側中央區淋巴結轉移相關因素的探討. 中國腫瘤臨床, 2017, 44(1): 41-45.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Value of pretracheal lymph node subdivision in predicting contralateral central lymph node metastasis for cN0 unilateral papillary thyroid carcinoma

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