Diagnosis and treatment of occult carcinoma of the thyroid with neck lymph node metastasis as the first symptom_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HU Hongsheng , SUN Shaohua , SHEN Feng , WU Hongwei , ZHANG Zhen , FANG Dazheng ,  ZHOU Wenbo

Thyroid Diagnosis and Treatment Center, Dongfeng Hospital of Hubei University of Medicine, Shiyan, Hubei 442008, P.R.China;

Corresponding author：

ZHOU Wenbo, Email: zwbmail@163.com

Keywords：

occult carcinoma of the thyroid; neck lymph node metastasis; the first symptom; diagnosis; treatment

DOI：

10.7507/1007-9424.201608026

Video：

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Objective To investigate the optimal diagnosis and treatment strategy of occult carcinoma of the thyroid (OCT) with neck lymph node metastasis as the first symptom. Method In order to discuss the optimal diagnosis and treatment strategy of OCT with neck lymph node metastasis as the first symptom, we collected 35 cases and analyzed their characteristics, diagnostic methods, operative schemes, metastasis situation, and death situation. Results Of the 35 cases, 28 cases went to hospital because of swollen lymph nodes, and other 7 cases were discovered by color Doppler ultrasound in medical examination. Thyroid nodules were found by color Doppler ultrasound in 32 cases, 3 cases were found no thyroid nodule. Lymph node of 23 cases were determined by ultrasound-guided fine-needle aspiration biopsy (US-FNAB), and 16 cases (69.56%) were diagnosed as metastasis of thyroid carcinoma or suspicious metastasis by US-FNAB. Thyroid biopsy were done in 21 cases, and 11 cases (52.38%) were diagnosed as thyroid carcinoma or suspicious thyroid carcinoma by fine needle aspiration biopsy. Of the 35 cases, 19 cases were performed total thyroidectomy and functional neck lymph node dissection, 11 cases were performed resection of unilateral thyroid and isthmus and regional neck lymph node dissection, 5 cases were performed nonstandard operations. All cases were followed up for 3–10 years after operation, and the median time was 7-year. During follow up period, 10 cases suffered from reccurrence. Among them, 3 cases reoccurred in the nonstandard operation group, 5 cases reoccurred in resection of unilateral thyroid and isthmus and regional neck lymph node dissection group, 3 cases reoccurred in total thyroidectomy and functional neck lymph node dissection group. There were 3 cases died. Among them, there was 1 case in each group of nonstandard operation group, resection of unilateral thyroid and isthmus and regional neck lymph node dissection group, and total thyroidectomy and functional neck lymph node dissection group. The recurrence rate of total thyroidectomy and functional neck lymph node dissection group was markedly lower than those of resection of unilateral thyroid and isthmus and regional neck dissection group (χ²=4.751,P<0.05) and nonstandard operation group (χ²=5.874,P<0.05). While there was no significance difference of the recurrence rate between the resection of unilateral thyroid and isthmus and regional neck dissection group and nonstandard operation group (χ²=0.291,P>0.05). There was no significance difference in the mortality among the three groups (P>0.05). Conclusion US-FNAB and intraoperation rapid frozen pathological section are important methods for diagnosis of OCT with neck lymph node metastasis as the first symptom, and standard operation is an principal treatment method for it.

Citation： HU Hongsheng, SUN Shaohua, SHEN Feng, WU Hongwei, ZHANG Zhen, FANG Dazheng, ZHOU Wenbo. Diagnosis and treatment of occult carcinoma of the thyroid with neck lymph node metastasis as the first symptom. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(3): 355-360. doi: 10.7507/1007-9424.201608026 Copy

1.	苏汝康, 郭斌. 54 例隐匿性甲状腺癌诊治的回顾性分析. 中国中西医结合外科杂志, 2014, 20(1): 21-24.
2.	贺晓斌, 贺宝艳, 陈武科, 等. 隐匿性甲状腺癌的诊断及手术治疗(附 68 例报告). 现代肿瘤医学, 2012, 2(2): 274-276.
3.	胡洪生, 周文波, 孙少华, 等. 甲状腺癌颈部淋巴结转移彩超特点分析. 湖北医药学院学报, 2015, 34(2): 155-158.
4.	American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer; Cooper DS, Doherty GM, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 2009, 19(11): 1167-1214.
5.	全丽娟, 朱文军, 孟彬, 等. 甲状腺微小乳头状癌超声声像图特征预测颈部淋巴结转移的价值. 中国临床医学影像杂志, 2013, 24(4): 272-274.
6.	许莉华, 黄斌. 高频超声在甲状腺囊实性结节良恶性鉴别中的应用. 中国现代医生, 2016, 54(1): 126-128.
7.	彭玉兰, 马步云, 于波洋, 等. 甲状腺微小癌的超声研究现状与进展. 西部医学, 2016, 28(4): 448-452.
8.	王刚, 杨超, 李大强, 等. 高频超声检查甲状腺乳头状癌超声图像的特征分析. 中国肿瘤临床与康复, 2015, 22(10): 1192-1193.
9.	Remonti LR, Kramer CK, Leitão CB, et al. Thyroid ultrasound features and risk of carcinoma: a systematic review and meta-analysis of observational studies. Thyroid, 2015, 25(5): 538-550.
10.	汪宏梅. 133例颈部淋巴结细针穿刺细胞学分析. 西部医学, 2012, 24(7): 1377-1378.
11.	Khan S, Omar T, Michelow P. Effectiveness of the cell block technique in diagnostic cytopathology. J Cytol, 2012, 29(3): 177-182.
12.	宣之东, 郑雪, 周利. 超声引导下浅表淋巴结细针穿刺活检的临床应用. 疑难病杂志, 2014, 13(5): 494-496.
13.	刘晓晖, 华玺, 丁鹏, 等. 超声引导下颈淋巴结穿刺活检对甲状腺癌诊断的临床价值. 实用癌症杂志, 2016, 31(7): 1911-1913.
14.	National Comprehensive Cancer Network. NCCN clinical practice guidelines for treatment of cancer: thyroid carcinoma V. 2. 2015. 2016-03-15. http://www.nccn.org/professionals/physician_gls/ pdf/thyroid.pdf.
15.	Haugen BR, Alexander EK, Bible KC, et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid, 2016, 26(1): 1-133.
16.	Perros P, Boelaert K, Colley S, et al. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf), 2014, 81 Suppl 1: 1-122.
17.	Dean DS, Gharib H. Fine-needle aspiration biopsy of the thyroid gland. 2015-04-26. https://www.ncbi.nlm.nih.gov/books/ NBK285544/.
18.	孙辉, 刘晓莉. 甲状腺癌规范化诊治理念更新及其意义. 中国实用外科杂志, 2015, 35(1): 72-75.
19.	赵彦广. 隐匿性甲状腺癌的临床诊治//中国抗癌协会甲状腺癌专业委员会, 中国抗癌协会头颈肿瘤专业委员会, 中华医学会肿瘤分会头颈学组. 2014第六届全国甲状腺肿瘤学术大会论文集. 中国天津, 2014.
20.	Yang GC, LiVolsi VA, Baloch ZW. Thyroid microcarcinoma: fine-needle aspiration diagnosis and histologic follow-up. Int J Surg Pathol, 2002, 10(2): 133-139.
21.	Boucek J, Kastner J, Skrivan J. Occult thyroid carcinoma . Acta Otorhinolaryngol Ital, 2009, 29(6): 296-304.
22.	Piana S, Ragazzi M, Tallini G, et al. Papillary thyroid microcarcinoma with fatal outcome evidence of tumor progression in lymph node metastases. Hum Pathol, 2013, 44(4): 556-565.
23.	张强, 张仑, 宋方方, 等. 甲状腺乳头状癌颈部淋巴结转移规律临床分析. 中国耳鼻咽喉头颈外科, 2010, 1(12): 639-642.
24.	姜军, 李世超. 分化型甲状腺癌淋巴结转移特点及颈侧方淋巴结清扫术局部应用解剖. 中国实用外科杂志, 2011, 31(5): 380-383.
25.	张卧, 罗定存. 颈侧区淋巴结转移阳性甲状腺乳头状癌颈淋巴结转移规律分析. 现代实用医学, 2012, 24(10): 1135-1136.
26.	刘妍, 景尚华. 甲状腺微小癌的诊断与治疗进展. 实用癌症杂志, 2016, 31(1): 171-173.
27.	赵朋, 苏新良. 甲状腺微小乳头状癌治疗方式探讨. 现代医药卫生, 2016, 32(6): 858-860.
28.	Macedo FI, Mittal VK. Total thyroidectomyversus lobectomy as initial operation for small unilateral papillary thyroid carcinoma: a meta-analysis. Surg Oncol, 2015, 24(2): 117-122.
29.	胡洪生, 周文波, 沈丰, 等. 甲状腺乳头状癌合并髓样癌1例报告. 中国实用外科杂志, 2015, 35(2): 234, 236.

1. 苏汝康, 郭斌. 54 例隐匿性甲状腺癌诊治的回顾性分析. 中国中西医结合外科杂志, 2014, 20(1): 21-24.
2. 贺晓斌, 贺宝艳, 陈武科, 等. 隐匿性甲状腺癌的诊断及手术治疗(附 68 例报告). 现代肿瘤医学, 2012, 2(2): 274-276.
3. 胡洪生, 周文波, 孙少华, 等. 甲状腺癌颈部淋巴结转移彩超特点分析. 湖北医药学院学报, 2015, 34(2): 155-158.
4. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer; Cooper DS, Doherty GM, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 2009, 19(11): 1167-1214.
5. 全丽娟, 朱文军, 孟彬, 等. 甲状腺微小乳头状癌超声声像图特征预测颈部淋巴结转移的价值. 中国临床医学影像杂志, 2013, 24(4): 272-274.
6. 许莉华, 黄斌. 高频超声在甲状腺囊实性结节良恶性鉴别中的应用. 中国现代医生, 2016, 54(1): 126-128.
7. 彭玉兰, 马步云, 于波洋, 等. 甲状腺微小癌的超声研究现状与进展. 西部医学, 2016, 28(4): 448-452.
8. 王刚, 杨超, 李大强, 等. 高频超声检查甲状腺乳头状癌超声图像的特征分析. 中国肿瘤临床与康复, 2015, 22(10): 1192-1193.
9. Remonti LR, Kramer CK, Leitão CB, et al. Thyroid ultrasound features and risk of carcinoma: a systematic review and meta-analysis of observational studies. Thyroid, 2015, 25(5): 538-550.
10. 汪宏梅. 133例颈部淋巴结细针穿刺细胞学分析. 西部医学, 2012, 24(7): 1377-1378.
11. Khan S, Omar T, Michelow P. Effectiveness of the cell block technique in diagnostic cytopathology. J Cytol, 2012, 29(3): 177-182.
12. 宣之东, 郑雪, 周利. 超声引导下浅表淋巴结细针穿刺活检的临床应用. 疑难病杂志, 2014, 13(5): 494-496.
13. 刘晓晖, 华玺, 丁鹏, 等. 超声引导下颈淋巴结穿刺活检对甲状腺癌诊断的临床价值. 实用癌症杂志, 2016, 31(7): 1911-1913.
14. National Comprehensive Cancer Network. NCCN clinical practice guidelines for treatment of cancer: thyroid carcinoma V. 2. 2015. 2016-03-15. http://www.nccn.org/professionals/physician_gls/ pdf/thyroid.pdf.
15. Haugen BR, Alexander EK, Bible KC, et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid, 2016, 26(1): 1-133.
16. Perros P, Boelaert K, Colley S, et al. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf), 2014, 81 Suppl 1: 1-122.
17. Dean DS, Gharib H. Fine-needle aspiration biopsy of the thyroid gland. 2015-04-26. https://www.ncbi.nlm.nih.gov/books/ NBK285544/.
18. 孙辉, 刘晓莉. 甲状腺癌规范化诊治理念更新及其意义. 中国实用外科杂志, 2015, 35(1): 72-75.
19. 赵彦广. 隐匿性甲状腺癌的临床诊治//中国抗癌协会甲状腺癌专业委员会, 中国抗癌协会头颈肿瘤专业委员会, 中华医学会肿瘤分会头颈学组. 2014第六届全国甲状腺肿瘤学术大会论文集. 中国天津, 2014.
20. Yang GC, LiVolsi VA, Baloch ZW. Thyroid microcarcinoma: fine-needle aspiration diagnosis and histologic follow-up. Int J Surg Pathol, 2002, 10(2): 133-139.
21. Boucek J, Kastner J, Skrivan J. Occult thyroid carcinoma . Acta Otorhinolaryngol Ital, 2009, 29(6): 296-304.
22. Piana S, Ragazzi M, Tallini G, et al. Papillary thyroid microcarcinoma with fatal outcome evidence of tumor progression in lymph node metastases. Hum Pathol, 2013, 44(4): 556-565.
23. 张强, 张仑, 宋方方, 等. 甲状腺乳头状癌颈部淋巴结转移规律临床分析. 中国耳鼻咽喉头颈外科, 2010, 1(12): 639-642.
24. 姜军, 李世超. 分化型甲状腺癌淋巴结转移特点及颈侧方淋巴结清扫术局部应用解剖. 中国实用外科杂志, 2011, 31(5): 380-383.
25. 张卧, 罗定存. 颈侧区淋巴结转移阳性甲状腺乳头状癌颈淋巴结转移规律分析. 现代实用医学, 2012, 24(10): 1135-1136.
26. 刘妍, 景尚华. 甲状腺微小癌的诊断与治疗进展. 实用癌症杂志, 2016, 31(1): 171-173.
27. 赵朋, 苏新良. 甲状腺微小乳头状癌治疗方式探讨. 现代医药卫生, 2016, 32(6): 858-860.
28. Macedo FI, Mittal VK. Total thyroidectomyversus lobectomy as initial operation for small unilateral papillary thyroid carcinoma: a meta-analysis. Surg Oncol, 2015, 24(2): 117-122.
29. 胡洪生, 周文波, 沈丰, 等. 甲状腺乳头状癌合并髓样癌1例报告. 中国实用外科杂志, 2015, 35(2): 234, 236.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Diagnosis and treatment of occult carcinoma of the thyroid with neck lymph node metastasis as the first symptom

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