ObjectiveTo evaluate the pattern and predictive factors of regional lymph node metastasis in papillay thyroid carcinoma (PTC).
MethodsThe clinical data of 223 patients with PTC whom suffered operation from Dec.2008 to Dec.2011 in our hospital were retrospective analyzed.The relationship among the lymph node metastasis of different area of the neck and patient's sex, age, preoperative TSH level, tumor size, multifocality, extracapsular spread, Hashimoto thyroiditis, nodular goiter, and the T classification of the tumors were analyzed.
ResultsThe univariate analysis results showed that patient's age≥45 years old and associated with nodular goiter were statistically significantly related to central lymph node metastasis (P < 0.05), for lateral lymph node metastases, the multifocality were statistically significant (P < 0.05).The multivariate analysis results showed that patient's age≥45 years old and associated with nodular goiter were protective factors for central lymph node metastasis (P < 0.05), for lateral lymph node metastasis, the multifocality was risk factor (P < 0.05).Most of the lateral lymph node metastases were confined to levels Ⅱ-Ⅳ, and the incidence of level Ⅲ was as highest as 100%.When the skip metastasis, the levels Ⅱ-Ⅳ were the transfer of high incidence areas.
ConclusionsWhen age < 45 years old of patients with PTC, the central neck dissection should be routine performed.The incidence of central lymph node metastasis will decrease if associated with nodular goiter.Because multifocality is a risk factor for lateral lymph node metastasis, careful inspection levels Ⅱ-Ⅳ should be performed during operation, espe-cially level Ⅲ lymph nodes.If skip metastasis is present, levels Ⅱ-Ⅳ dissection would be a proper treatment option.
ObjectiveTo investigate the relationship of concomitant BRAFV600E gene mutation with the predictive factors of papillay thyroid microcarcinoma(PTMC).
MethodsBy fluorescence quantitative PCR method to detect BRAFV600E gene mutation of PTMC of 86 cases, and to detect the relationship with clinical pathological features of PTMC by single factor and multi-factor logistic regression analysis.
ResultsThe morbidity of BRAFV600E gene mutation was 65.1%(56/86). By univariate analysis, BRAFV600E gene mutation status showed a related trend with lymph node metastasis(P=0.057). The multivariate analysis showwd that lymph node metastasis was correlated with BRAF V600E gene mutation(P < 0.05). When the diameter of tumor > 5 mm and≤10mm, BRAFV600E gene mutation was no statistically significantly related to central lymph node metastasis(P > 0.05). When BRAFV600E gene mutations was negative in patients with tumor diameter≤5 mm, no lymph node metastasis sample appeared.
ConclusionsThe presence of BRAFV600E gene mutation is an independent predictive factor for central lymph node metastasis. When PTC with preoperative BRAFV600E gene mutation positive, the central neck dissection should be routine performed. There should be re-examined the necessity of preventative central lymph node disection when the tumor diameter is 5 mm or less with the patients which mutation negative.
