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, 李进, 程颖, 等. 中国临床肿瘤学会(CSCO)分化型甲状腺癌诊疗指南2021. 肿瘤预防与治疗, 2021, 34(12): 1164-1201.
2.	彭琛, 魏松锋, 郑向前, 等. 1 401例甲状腺微小乳头状癌临床病理特征及中央区淋巴结转移危险因素分析. 中国肿瘤临床, 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.	朱精强. 分化型甲状腺癌颈淋巴结清扫的相关问题. 中国普外基础与临床杂志, 2012, 19(8): 809-813.
13.	朱精强, 雷建勇, 姜可. 甲状腺微小乳头状癌淋巴结转移特点及处理策略. 中国普外基础与临床杂志, 2016, 23(10): 1160-1165.
14.	苏安平, 邢志超, 朱精强. 甲状腺术后甲状旁腺功能低下的定义及意义. 中国普外基础与临床杂志, 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. 单侧甲状腺乳头状癌对侧中央区淋巴结转移的相关危险因素研究分析. 太原: 山西医科大学, 2020.
21.	丁金旺, 彭友, 张卧, 等. 单侧甲状腺乳头状癌对侧中央区淋巴结转移的临床危险因素分析. 中国耳鼻咽喉头颈外科, 2018, 25(8): 406-410.
22.	潘烨, 郑起. 甲状腺全切联合中央区淋巴结清扫术安全性的Meta分析. 中华内分泌外科杂志, 2010, 4(6): 379-382.
23.	胡治华, 华清泉. 分化型甲状腺癌cN0期Ⅵ区淋巴结清扫必要性的系统评价. 中国医药导报, 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.	林佳伟, 林炘, 杨熙鸿. 甲状腺癌手术喉返神经损伤的影响因素分析及预防. 中国耳鼻咽喉颅底外科杂志, 2021, 27(6): 702-705.
27.	李新营, 王志明, 吕新生, 等. 甲状腺疾病再次手术的原因及并发症分析. 中国普通外科杂志, 2005, 14(9): 644-647.
28.	朱精强, 苏安平, 王明俊. 《甲状腺围手术期甲状旁腺功能保护指南(2018版)》解读. 中国普外基础与临床杂志, 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.	高庆军, 王南鹏, 周彦, 等. 甲状腺乳头状癌颈部淋巴结转移规律及影响因素分析. 中国普外基础与临床杂志, 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.	何伟, 苏新良, 吴凯南, 等. cN0甲状腺乳头状癌对侧中央区淋巴结转移相关因素的探讨. 中国肿瘤临床, 2017, 44(1): 41-45.

1. 赫捷, 李进, 程颖, 等. 中国临床肿瘤学会(CSCO)分化型甲状腺癌诊疗指南2021. 肿瘤预防与治疗, 2021, 34(12): 1164-1201.
2. 彭琛, 魏松锋, 郑向前, 等. 1 401例甲状腺微小乳头状癌临床病理特征及中央区淋巴结转移危险因素分析. 中国肿瘤临床, 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. 朱精强. 分化型甲状腺癌颈淋巴结清扫的相关问题. 中国普外基础与临床杂志, 2012, 19(8): 809-813.
13. 朱精强, 雷建勇, 姜可. 甲状腺微小乳头状癌淋巴结转移特点及处理策略. 中国普外基础与临床杂志, 2016, 23(10): 1160-1165.
14. 苏安平, 邢志超, 朱精强. 甲状腺术后甲状旁腺功能低下的定义及意义. 中国普外基础与临床杂志, 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. 单侧甲状腺乳头状癌对侧中央区淋巴结转移的相关危险因素研究分析. 太原: 山西医科大学, 2020.
21. 丁金旺, 彭友, 张卧, 等. 单侧甲状腺乳头状癌对侧中央区淋巴结转移的临床危险因素分析. 中国耳鼻咽喉头颈外科, 2018, 25(8): 406-410.
22. 潘烨, 郑起. 甲状腺全切联合中央区淋巴结清扫术安全性的Meta分析. 中华内分泌外科杂志, 2010, 4(6): 379-382.
23. 胡治华, 华清泉. 分化型甲状腺癌cN0期Ⅵ区淋巴结清扫必要性的系统评价. 中国医药导报, 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. 林佳伟, 林炘, 杨熙鸿. 甲状腺癌手术喉返神经损伤的影响因素分析及预防. 中国耳鼻咽喉颅底外科杂志, 2021, 27(6): 702-705.
27. 李新营, 王志明, 吕新生, 等. 甲状腺疾病再次手术的原因及并发症分析. 中国普通外科杂志, 2005, 14(9): 644-647.
28. 朱精强, 苏安平, 王明俊. 《甲状腺围手术期甲状旁腺功能保护指南(2018版)》解读. 中国普外基础与临床杂志, 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. 高庆军, 王南鹏, 周彦, 等. 甲状腺乳头状癌颈部淋巴结转移规律及影响因素分析. 中国普外基础与临床杂志, 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. 何伟, 苏新良, 吴凯南, 等. cN0甲状腺乳头状癌对侧中央区淋巴结转移相关因素的探讨. 中国肿瘤临床, 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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