Clinical analysis of level II occult metastasis of papillary thyroid carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the relevant factors occult II lymph node metastases in papillary thyroid carcinoma (PTC) with clinical factors.</p><p><b>METHODS</b>The medical records of 213 PTC patients with clinically positive neck lymph nodes in level III and IV, and/or V based on preoperative ultrasonography, treated between January 2003 and December 2009 were retrospectively reviewed. All patients had no suspicion of clinical positive neck nodes in level II. Univariate and Multivariate analysis were performed using the Pearson chi-square test or Fisher's exact test and a binary logistic regression test, respectively.</p><p><b>RESULTS</b>The rate of metastasis at levels III, IV, V and VI was 83.6% (178/213), 75.1% (160/213), 13.1% (28/213) and 79.3% (169/213), respectively. The rate of occult metastasis at level II were observed in 16.0% (34/213). In univariate analysis, lymph node metastasis in level II was statistically significantly more frequent in patients with positive level III lymph node and positive lymph node throughout the lateral neck (level III + IV, χ(2) were 11.120 and 5.614 respectively, P < 0.05). Multivariate analysis showed that positive lymph node involvement in all lateral neck (level III + IV) was an independent predictive factor of level II lymph node metastasis (P = 0.033, OR = 3.846).</p><p><b>CONCLUSION</b>In PTC patients without suspicious lymph node in neck level II and III by preoperative US, prophylactic level II lymph node dissection may not be considered.</p>

Clinical analysis of level V occult metastasis of papillary thyroid carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the occult level V lymph node (LN) metastases in papillary thyroid carcinoma (PTC) with clinical factors.</p><p><b>METHODS</b>The clinical data of 203 PTC patients with clinical positive neck lymph nodes in level II, III and IV based on preoperative ultrasonography, who underwent therapeutic lateral neck dissection (level II-V) between January 2001 and June 2009 were retrospectively reviewed. There were 60 male and 143 female patients in the study. The median age at diagnosis was 42 years (ranging from 16 to 76 years). The 203 patients had undergone ipsilateral thyroidectomy and simultaneously neck dissections (II-VI). All patients had no suspicion of clinical positive neck nodes in level V. Univariate and Multivariate analysis were performed using the Pearson chi-square test and a binary logistic regression test, respectively.</p><p><b>RESULTS</b>The rate of metastatic at levels II, III and IV was 47.3%(96/203), 79.8%(162/203), 81.3% (165/203), respectively. The rate of occult metastatic at level V were observed in 14.3%(29/203). In univariate analysis, LN metastasis in level V was statistically significantly more frequent in patients with positive level IV LNs (χ(2) = 5.651, P = 0.017) and positive LNs throughout the lateral neck (level III+IV) (χ(2) = 10.936, P = 0.001). Multivariate analysis showed that positive LN involvement in all lateral neck (level III+IV) is an independent predictive factor of level V LN metastasis (P = 0.046, OR = 4.550).</p><p><b>CONCLUSION</b>In PTC patients without suspicious LNs in neck level IV by preoperative ultrasound, prophylactic level V LN dissection may be omitted.</p>