Objective
To investigate the value of sentinel lymph node biopsy (SLNB) in predicting the metastasis of central cervical lymph nodes (CCLN) in differentiated thyroid carcinoma, and to explore reasonable program for CCLN dissection.
Methods
This retrospective analysis was performed basing on the clinical data of 407 patients with differentiated thyroid carcinoma who were admitted to the Department of General Surgery of Xuanwu Hospital from June 2013 to December 2016, including 237 patients with microcarcinoma.
Results
① The results of the lymph nodes detection. All patients had detected 7 766 lymph nodes (1 238 metastatic lymph nodes were detected from 219 patients), and 2 085 sentinel lymph nodes were detected (448 metastatic sentinel lymph nodes were detected from 189 patients). In the patients with microcarcinoma, there were 3 614 lymph nodes were detected (390 metastatic lymph nodes were detected from 97 patients), and 1 202 sentinel lymph nodes were detected (149 metastatic sentinel lymph nodes were detected from 82 patients). ② The value of SLNB to predict CCLN metastasis. The sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of SLNB to predict CCLN metastasis for all patients was 86.30% (189/219), 100% (188/188), 0 (0/189), 13.70% (30/219), 100% (189/189), and 86.24% (188/218) respectively; for patients with microcarcinoma was 84.54% (82/97), 100% (140/140), 0 (0/82), 15.46% (15/97), 100% (82/82), and 90.32% (140/155), respectively. ③ The value of SLNB to predict the presence of additional positive lymph nodes (APLN). The sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of SLNB to predict the APLN for all patients was 81.48% (132/162), 76.73% (188/245), 23.27% (57/245), 18.52% (30/162), 69.84% (132/189) and 86.24% (188/218), respectively; for patients with microcarcinoma was 73.68% (42/57), 77.78% (140/180), 22.22% (40/180), 26.32% (15/57), 51.22% (42/82) and 90.32% (140/155) respectively. ④ The value of positive sentinel lymph node ratio (PSLNR) to predict the presence of the APLN. The sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of PSLNR to predict the APLN for all patients was 71.97%, 78.95%, 21.05%, 28.03%, 88.79%, and 54.88% respectively, and the cutoff for PSLNR was 0.345 2. For patients with microcarcinoma, the sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of PSLNR to predict the APLN was 83.33%, 67.50%, 32.50%, 16.67%, 72.92%, and 79.41% respectively, and the cutoff for PSLNR was 0.291 7.
Conclusion
There is an important predicted value of SLNB for CCLN dissection in the patients suffered from differentiated thyroid carcinoma, and the PSLNR is a reliable basis for CCLN dissection.
ObjectiveTo explore the clinical pattern of intrapulmonary lymph node metastasis and the significance of No.13 and No.14 lymph nodes biopsy in patients with non-small cell lung cancer (NSCLC).MethodsThe clinical data of 234 patients with primary peripheral NSCLC who underwent systemic dissection of intrathoracic lymph nodes and intrapulmonary lymph nodes in the First Affiliated Hospital of Chongqing Medical University between 2013 and 2015 were retrospectively analyzed. There were 159 males and 75 females, aged 36-89 (61.35±8.57) years. Statistical analysis was performed accordingly on hilar (No.10), interlobar (No.11), lobar (No.12) and segmental (No.13 and 14) sites of the samples of N1 lymph nodes after surgery.ResultsA total of 3 019 lymph nodes of No.10-14 were dissected in 234 patients (12.9 per patient). The 263 lymph nodes were positive with a rate of 8.71% (263/3 019) and lymph node metastasisa occured in 99 patients with a rate of 42.31% (99/234), among whom there were 40 patients of N1 metastasis, 48 of N1+N2 metastasis and 11 of N2 skipping metastasis. Routine pathological examination demonstrated No.13 and No.14 lymph nodes metastasis in 16 patients with a rate of 6.84% (16/234). In 886 dissected lymph nodes of No.13 and No.14, 86 lymph nodes showed metastasis with a rate of 9.71% (86/886). Of the patients with swelling hilar and mediastinal lymph nodes reported by preoperative CT scan, only 56.32% of them were confirmed with lymph node metastasis by postoperative histopathology; while 34.01% of the patients with normal size lymph nodes had lymph node metastasis.ConclusionIn the surgical treatment of NSCLC, it is necessary to detect the metastasis of No. 13 and 14 lymph nodes and non-tumor parabronchial lymph nodes, which is helpful to obtain accurate postoperative TNM staging and is of great significance for guiding postoperative treatment. Preoperative CT is not a reliable method to judge lymph node metastasis, particularly for intrapulmonary lymph node metastasis.
Objective
To summarize the influencing factors of central lymph node metastasis in thyroid papillary carcinoma.
Method
Relevant literature about papillary thyroid carcinoma were reviewed and predictive factors of central lymph node metastasis were summarized.
Results
Studies had shown that, male, younger age, larger tumor size, multifocal, and BRAF mutations were risk factors for central lymph node metastasis in thyroid papillary carcinoma, while tumors located in the upper pole and combined with Hashimoto disease (HT) were the protective factors for central lymph node metastasis.
Conclusions
The central lymph node metastasis detection rate is low, so it is unable to meet with the preoperative diagnosis in papillary thyroid carcinoma. A large number of studies have confirmed that clinical pathological features have predictive value for preoperative lymph node diagnosis, and can provide a reference for the selection of surgical methods in thyroid papillary carcinoma.
ObjectiveTo investigate the metastatic status and risk factors of axillary non-sentinel lymph node (NSLN) in breast cancer patients with 1–2 positive sentinel lymph nodes (SLN), and to provide theoretical basis for exemption of axillary lymph node dissection (ALND) in these patients. Methods A retrospective analysis was performed on 54 patients diagnosed with breast cancer who underwent sentinel lymph node biopsy (SLNB) and confirmed to have 1–2 positive sentinel lymph nodes (SLNS) and received ALND in the Department of Thyroid and Breast Surgery of Tongling People’s Hospital from January 2018 to April 2023. The patients were divided into NSLN metastatic group (17 cases) and NSLN non-metastatic group (37 cases) according to whether there was metastasis. Chi-square test was used to compare the basic information and clinicpathological features of the two groups. The independent risk factors for axillary NSLN metastasis were screened out by multivariate binary logistic regression model. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of independent risk factors combined with axillary NSLN metastasis. Results There were 54 cases with 1–2 metastasis of SLN, 17 cases with axillary NSLN metastasis (31.5%). The incidence of axillary NSLN metastasis in patients with tumor at T1 stage (maximum diameter ≤2 cm) was only 14.3% (4/28), however, the metastatic rate of axillary NSLN in patients with tumor in T2–T3 stage (maximum diameter >2 cm) was as high as 50.0% (13/26). The axillary NSLN metastasis rate was only 21.2% (7/33) with 1 SLN metastasis, while the axillary NSLN metastasis rate was 47.6% (10/21) with 2 SLN metastasis. Univariate analysis showed that T stage (tumor diameter >2 cm), 2 SLN metastases, number of SLN >5 and tumor with vascular embolus were more likely to develop axillary NSLN metastases (P<0.05). Multivariate binary logistic regression analysis showed that T stage (tumor diameter >2 cm) and 2 SLN metastases were independent risk factors for axillary NSLN metastasis in breast cancer patients, the area under ROC curve of combined prediction of axillary NSLN metastasis by the two was 0.747, 95%CI was (0.657, 0.917), sensitivity was 0.765 and specificity was 0.649. Conclusions The combination of tumor T stage and the number of SLN metastases can better predict axillary NSLN metastasis in breast cancer patients. ALND is recommended for breast cancer patients with T stage (tumor diameter >2 cm) and 2 SLN metastases to reduce the risk of residual axillary NSLN metastasis.
Objective To summarize the research progress on diagnostic criteria of lymph node metastasis in medullary thyroid carcinoma (MTC), and the indication and scope of lateral cervical lymph node dissection (LCLND). Method By searching PubMed and CNKI databases, the related guidelines and literature about the diagnosis and treatment of lateral cervical lymph node metastasis in MTC in recent years were obtained and reviewed. Results The metastatic rate of lateral cervical lymph nodes in MTC patients was high. The indication of LCLND was both consensus and controversy. The LCLND of MTC was also controversial, and the focus of controversy mainly focused on the survival rate, recurrence rate, distant metastasis and postoperative complications of patients receiving prophylactic LCLND. Different imaging methods had their own advantages and disadvantages in diagnosing lymph node metastasis of MTC. Nuclear medicine was effective but expensive. Fine needle puncture was also an effective method for the diagnosis of lymph node metastasis of MTC. At present, calcitonin level, tumor size and lymph node metastasis were still important indicators for evaluating MTC for prophylactic LCLND, but the application of related indications had not been unified. Many scholars recommended comprehensive consideration of various indicators to evaluate whether MTC carried out preventive LCLND. Conclusions The LCLND of MTC needs to be further explored and standardized on the basis of the existing consensus. The focus of prophylactic LCLND should be to improve the survival rate of patients while reducing complications as much as possible.
ObjectiveTo summarize the current status and advances of sentinel lymph node biopsy (SLNB) technique in breast cancer. MethodsThe pertinent domestic and overseas literatures were reviewed and the localization, harvest, status assessment, indications, and complications of SLNB were analyzed. ResultsSLNB could accurately locate and pick out sentinel lymph node (SLN) in breast cancer. The development on imaging examination and pathological techniques promoted the assessment of SLN, and the indications of SLNB were expanding. The complication rate of SLNB was low and the technique could accurately predict axillary lymph node staging and direct selective axillary lymph node dissection. ConclusionsSLNB has been an important method of surgical therapy in breast cancer, but the operation process needs to be further standardized to decrease the false negative rate. Continuative attentions shall be paid to the problems such as the false positive and controversial indications.
Objective
To investigate the effect of modular disscection of mediastinal lymphadenectomy in uniportal video-assisted thoracoscopic surgery (uniportal-VATS) for lung cancer radical resection and assess its safety and feasibility.
Methods
Data of 311 patients (171 males and 140 females, a mean age of 59.4±5.1 years) with non-small cell lung cancer (NSCLC) who received modular dissection of mediastinal lymphadenectomy in uniportal-VATS or three portal VATS (3P-VATS group) during March to December 2015 were retrospectively analyzed. There were 208 patients (110 males and 98 females, a mean age of 59.2±5.3 years) in the uniportal-VATS group and 103 patients (61 males and 42 femals, a mean age of 59.7±5.1 years) in the 3P-VATS group. The effects of lymph nodes (LNs) dissection and postoperative clinical data were compared between the two groups, especially for N2 LNs dissection.
Results
There were no perioperative death in two groups. The overall number of dissected stations and LNs in the uniportal-VATS group (7.3±1.0, 17.5±3.0) were similar with those in the 3P-VATS group (7.2±1.0, 17.7±2.7, P=0.208, P=0.596). The dissected stations (uniportal-VATS: 4.3±0.7, 3P-VATS: 4.3±0.6) and number (uniportal-VATS: 8.6±1.1, 3P-VATS: 8.5±1.1) of N2 LNs were both similar between the two groups (P=0.850, P=0.587). The chest tube duration and postoperative hospital stay of uniportal-VATS group (4.4±1.3 d and 9.2±0.9 d) were much shorter than those of 3P-VATS group (5.0±1.3 d and 9.8±2.0 d, both P<0.001). No significant difference was found in morbidity rate between the two groups (P>0.05).
Conclusion
Modular dissection of mediastinal lymphadenectomy could meet the requirment of radical resection and it is a safe and valid method which could be used during uniportal-VATS for radical resection of lung cancer.
ObjectiveTo summarize the research progress of sentinel lymph node biopsy (SLNB) in the surgery of thyroid carcinoma in recent years.
MethodsLiteratures about the recent studies on categories of SLNB and the neck lymph node dissection conducted by SLNB in the surgery of thyroid carcinoma were reviewed following the results searched from PubMed and CNKI data base.
ResultsSLNB has a high detection rate and it is of great significance to detect the occult metastatic lymph nodes and guide the neck lymph node dissection during operation.
ConclusionThe SLNB, with its high accuracy rate on the detection of occult metastatic lymph nodes, guides neck lymph node dissection during operation in order that it can maximize the benefits of patients.
ObjectiveTo analyze the predictive factors for central lymph node metastasis in papillary thyroid microcarcinoma (PTMC), and explore the treatment method for the patients with PTMC.
MethodThe literatures were reviewed according to the results searched from PubMed in recent years.
ResultsCentral lymph node metastases were common in the patients with PTMC. It was important for prophylactic central lymph node dissection so it might reduce the local recurrence and comfirm the clinical staging, further more provide the strategies for the postoperative therapy.
ConclusionsLymphadenectomy is necessary for patients with lymph node metastasis. Prophylactic central lymph node dissection should be performed for patients without lymph node metastasis but with one risk factor or more.
Objective To evaluate the safety，efficacy，short- and long-term clinical outcomes of complete video-assisted thoracoscopic surgery （VATS） lobectomy for non-small cell lung cancer （NSCLC）. Methods Clinical data of231 consecutive patients with NSCLC who underwent complete VATS lobectomy in the First Affiliated Hospital of NanjingMedical University between June 2006 and March 2011 were retrospective analyzed. There were 132 male and 99 femalepatients with their age of 15-81 （59.51±11.90） years. Preoperative cancer staging wasⅠa in 149 patients，Ⅰb in 50 patients，Ⅱa in 14 patients，Ⅱb in 13 patients and Ⅲa in 5 patients. There were 152 patients with adenocarcinoma，41 patients with squamous carcinoma，23 patients with bronchioalveolar carcinoma，5 patients with adenosquamous carcinoma，4 patients with large cell carcinoma，and 6 patients with other carcinoma. Follow-up data were statistically analyzed，and short-and long-term survival rates were calculated. Results No perioperative mortality was observed. Operation time was 60-370（199.14±51.04） minutes，and intraoperative blood loss was 10-2 300 （168.19±176.39） ml. Thirty-seven patients had postoperative complications including air leak，pulmonary infection，atelectasis，arrhythmia，subcutaneous emphysema andothers，who were all cured after conservative treatment. Mean number of dissected lymph nodes was 11.14±5.49，and meannumber of explored nodal stations was 3.66±1.52. There were 51 patients （22.08%） whose postoperative cancer staging wasmore advanced than preoperative cancer staging. Postoperative hospital stay was 3-36 （10.79±5.13） days. Primary causesof prolonged postoperative hospitalization included pulmonary air leak，pulmonary infection，preoperative concomitant chronic pulmonary diseases （COPD，asthma），and moderate to severe pulmonary dysfunction. A total of 228 patients werefollowed up for a mean duration of 40.83 months （22-82 months），and 3 patients were lost during follow-up. Overall 5-yearsurvival rates were 85.78%，52.54% and 32.70% for stageⅠ，stageⅡand stageⅢ-Ⅳpatients respectively. Five-year cancerfreesurvival rates were 80.00%，45.37% and 20.99% for stageⅠ，stageⅡand stageⅢ-Ⅳpatients respectively. ConclusionThe advantages of VATS lobectomy include smaller surgical incision，less injury and postoperative pain，quicker postoperative recovery and shorter hospital stay. Long-term survival rate is comparable to previous international and Chinese studies. VATS lobectomy can anatomically achieve complete tumor resection and systematic lymph node dissection. VATS lobectomy will become a standard surgical procedure for NSCLC patients.
