Clinical effects of elective neck dissection on 5-year survival rate of patients with early oral squamous cell carcinoma / 口腔疾病防治

Objective@#To investigate the effect of elective neck dissection on the 5-year survival rate of patients with early oral squamous cell carcinoma.@*Methods@#The data of 100 patients with early oral squamous cell carcinoma (cT1-2N0M0) were retrospectively analyzed. In 61 cases, the primary tumor was subjected to elective neck dissection (END). Neck observation and follow-up (NOF) were performed in 39 cases with enlarged resection of primary lesions. Clinicopathological data such as pT staging, pathology classification,the rate of cervical lymph node metastasis and the 5-year survival rate of the patients were statistically analyzed.@*Results@#The 5-year survival rates of the END and NOF groups were 86.9% and 69.2%, respectively, and the difference was statistically significant (P=0.028). END treatment was significantly better than NOF in controlling cervical lymph node metastasis in early oral squamous cell carcinoma (P=0.009). After stratified analysis of histopathological features, the 5-year survival rate of patients with pathological T2 (pT2) stage OSCC in the END group was significantly higher than that in the NOF group (P=0.020). The 5-year survival rate of patients with moderate and poorly differentiated pathological grade OSCC in the END group was significantly higher than that in the NOF group (P=0.013). @*Conclusion @# END is effective for the management of the cervical lymph node metastasis rate in early OSCC patients. For patients with pT2 stage or low differentiation pathological grade, active END can significantly improve the 5-year survival rate.

Risk Factors of lateral cervical lymph node metastases and survival analysis in patients with medullary thyroid carcinoma / 中华内分泌外科杂志

Objective:To investigate the risk factors of cervical lymph node metastasis (LNM) and survival analysis in patients with medullary thyroid carcinoma (MTC) .Methods:93 patients with MTC admitted to the Department of General Surgery and Department of Otorhinolaryngology, First Medical Center of PLA General Hospital from Sep. 2008 to Aug. 2020 were analyzed retrospectively, including 45 males and 48 females, with an average age of 47 years old. SPSS 26.0 statistical software was used for data processing of the initial surgical year and procedures, tumor pathological stages, preoperative calcitonin (Ctn) level, preoperative carcinoembryonic antigen (CEA) level, LNM status, recurrence free survival (RFS) , etc. The risk factors of LNM and prognosis of MTC patients were analyzed by COX univariate and multivariate regression. Kaplan Meier method was used to estimate the survival rates of independent risk factors affecting prognosis and draw their survival curves.Results:The median follow-up time of 93 patients was 53 months, ranging from 2 to 192 months. The 1-year, 3-year, 5-year and 10-year survival rates were 97.8%, 96.6%, 94.6% and 88.9% respectively. Multivariate COX regression analysis showed that Initial surgical procedures ( P=0.018) and preoperative Ctn level ( P=0.012) were independent risk factors of central cervical LNM. Preoperative Ctn level ( P=0.028) and Capsule invasion ( P=0.024) were the independent risk factors of lateral cervical LNM. Preoperative Ctn level≥180.30 pg/ml and ≥234.15pg/ml indicated central and lateral cervical LNM respectively (all P<0.001) . Distant metastasis was an independent risk factor of RFS ( P=0.037) of MTC. Conclusions:Standardized surgical procedures are recommended for initial treatment of MTC, which can reduce the possibility of residual occult metastasis and the risk of reoperation. Distant metastasis affects prognosis of MTC.

Predictive Value of Depth of Invasion of Tongue Squamous Cell Carcinoma for Cervical Lymph Node Metastasis and Prognosis / 肿瘤防治研究

Objective To investigate the predictive value of depth of invasion (DOI) of tongue squamous cell carcinoma (TSCC) for cervical lymph node metastasis and prognosis. Methods We retrospectively analyzed the clinical and pathological data of 73 patients with T1/2 TSCC. ROC curve was used to determine the optimal cut-off value of DOI for predicting cervical lymph node metastasis, and logistic regression analysis was performed to analyze the related factors affecting cervical lymph node metastasis of TSCC. Kaplan-Meier method and Cox regression analysis were used for survival analysis. Results Among 73 patients, 18 patients were with lymph node metastasis and 55 patients were without lymph node metastasis. The median DOI with and without lymph node metastasis were 8.00 and 5.00 mm, respectively (P=0.003). The optimal cut-off value for DOI was 6.15 mm, with AUC 0.75 (95%CI: 64.1%~87.1%, P=0.001), sensitivity 77.8% and specificity 63.6%. DOI and pathological differentiation were independent prognostic factors for cervical lymph node metastasis in multivariate analysis. DOI, nerve invasion and pathological differentiation were independent prognostic factors of survival in Cox regression analysis. Conclusion DOI of TSCC patients has important predictive value for both cervical lymph node metastasis and prognosis. Neck lymph node dissection is recommended for patients with DOI > 6.15 mm to improve survival rate and reduce recurrence rate.

Research progress on the neck management of oral squamous cell carcinoma with clinically node-positive neck / 口腔疾病防治

@#Oral squamous cell carcinoma (OSCC) is the most common malignant tumor in the oral and maxillofacial regions. Cervical lymph node metastasis is not only an important biological behavior of oral cancer but also an important factor affecting the prognosis of oral cancer patients. As neck dissection is the most commonly used method of neck management, the appropriate choice of surgical procedure is very important. The current view is that radical neck dissection or modified radical neck dissection can be used for patients with clinically node-positive neck (cN+), while selective neck dissection can be used for patients with clinically node-negative neck (cN0). In recent years, selective neck dissection has been increasingly popularized and applied. Its implications are also gradually expanding from cN0 to cN+. However, there is still no consensus on whether selective neck dissection can also be used in patients with cN+ necks. This article reviews the clinical studies on the neck management of cN+ OSCC patients in recent years, analyzes the effects of different neck dissections on the prognosis of cN+ OSCC patients, and summarizes the treatment principles of neck management.

Diagnosis and prognosis of cervical lymph node metastases of squamous cell carcino-ma of unknown primary site / 中国肿瘤临床

Objective: To investigate the characteristics, diagnosis, primary detection, and prognosis of cervical lymph node metastases of squamous cell carcinoma of unknown primary site (SCCUP). Methods: This study retrospectively analyzed the clinical features and follow-up data of 262 patients with SCCUP. The Chi-square test were used to analyze the clinical performances, characteristics of pri-mary lesions, and sensitivity and specificity of examinations to identify original lesions. Factors related to the overall survival (OS) and progression-free survival (PFS) were also analyzed. Results: The 262 patients with SCCUP comprised more men, with a median age of 57 years. At the follow-up, 70 patients were diagnosed with primary lesions (26.7%), and the detection rates of primary lymph nodes in those who were male (30.1%), with a single lesion site (31%), and with levelⅣdisease (39.3%) were higher than those in patients who were female (17.4%), with multiple lesion sites (18.7%), and with levelⅡ/Ⅲdisease (20.8%). Compared with traditional imaging examinations, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) had higher sensitivity and speci-ficity in detecting the primary tumor. Survival analysis showed that distant metastasis was an independent risk factor affecting OS and PFS, and the effect of N stage on PFS was statistically significant. Conclusions: In SCCUP patients, the proportion of patients who were male, with a single lesion site, and with cervicalⅣlymph node metastasis had higher rates of detection of the primary sites. PET/CT examination is important for the diagnosis of SCCUP, as well as the detection of primary lesions. Advanced N stage and distant metasta-sis indicated poor prognosis.

Cervical lymph node metastasis regularity of hypopharyngeal carcinoma and its influence on prognosis / 中国肿瘤临床

Objective:To investigate the regularity of cervical lymph node metastasis of hypopharyngeal carcinoma and its influence on patient prognosis,to guide the therapeutic strategies for hypopharyngeal carcinoma.Methods:A total of 140 hypopharyngeal squmous cell carcinoma patients who received surgery in Tianjin Medical University Cancer Institute and Hospital from January 2000 to December 2016 were analyzed retrospectively.χ2test was adopted for the analysis of the counting data,and Kaplan-Meier method was used for survival analysis,and the Cox regression model was used to analyze the factors affecting the prognosis.Results:The total rate of lymph node metastasis was 68.6% of the total 140 patients.The rate of occult lymph node metastasis in cN0 patients was 25.0%.The rate of bilateral lymph node metastases was 25%.The most common areas of lymph node metastasis are region II,Ⅲ,andⅣ.The rates of lymph node metastasis were 10.7%,10.4%,7.9% in regionⅠ,ⅤandⅥ,respectively.The total rate of extranodal extension were 66.7%.Univariate analysis showed that cervical lymph node metastasis was closely related to tumor pathological grade(P=0.012),and was not related to gender,age,primary tumor site,tumor T stage(P<0.05).The 3-year and 5-year overall survival rates of patients were 61.0% and 49.1%, respectively.Cox regression analysis showed that the diameter of metastatic lymph nodes(P=0.012),number(P=0.039),and extranodal extension(P=0.010)were significantly related to the survival of patients with hypopharyngeal carcinoma.When the diameter of metastatic lymph nodes≥2.8 cm,number≥2,with extranodal extension,the prognosis is poor.Conclusions:Hypopharyngeal carcinoma has a dismal prognosis,with high rate of lymph node metastasis.Cervical lymph node metastasis is an important factor of the prognosis.The active treatment strategy for the lymph nodes is the key to improve the therapeutic effect of hypopharyngeal carcinoma.

Relationship between BRAFV600E gene and TERT promoter mutations with cervical lymph node metastasis in papillary thyroid carcinoma / 国际外科学杂志

Objective To clarify the role of BRAFV600E and TERT promoter mutations in cervical lymph node metastasis in papillary thyroid carcinoma.Methods The data of 432 patients with thyroid papillary carcinoma who underwent surgery from February 2017 to September 2017 at the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively.The mutation of BRAFV600E and TERT promoter was detected by Sanger sequencing.The effect of BRAFV600E and TERT on cervical lymph node metastasis in patients with papillary thyroid carcinoma was analyzed by Chi-square test.Results The mutation rates of BRAFV600E and TERT promoter were 77.8％ (336/ 432) and 5.3％ (23/432) respectively in 432 papillary thyroid carcinoma patients.The probability of cervical lymph node metastasis in patients with BRAFV600E mutation was significantly higher than that in non-mutation patients (P ＜ 0.05).The probability of cervical lymph node metastasis in patients with TERT promoter mutation was significantly higher than that in non-mutated patients (P ＜ 0.05).Patients with both BRAFV600E and TERT promotermutation had a significantly higher incidence of cervical lymph node metastases than patients with the BRAFV600E mutation alone (P ＜ 0.05).Conclusions The mutations of BRAFV600E and TERT promoter are closely relevant to the occurrence of cervical lymph node metastasis in papillary thyroid carcinoma.Preoperative fine-needle aspiration cytology and postoperative routine pathological molecular diagnosis can help clinicians to develop a more rational treatment strategy,and a more accurate assessment of the risk of relapse.

Predictive value of ultrasonographic features in cervical lymph node metastasis of PTC / 医学研究生学报

Objective At present,the detection rate of cervical metastatic lymph nodes in patients with papillary thyroid carcinoma (PTC) is relatively low by imaging technology.The article aimed to demonstrate the ultrasonographic features of PTC in predicting cervical lymph nodes metastasis(CLNM).Methods A retrospective analysis was done on 169 PTC patients proved by surgery and pathology who underwent cervical lymph node dissection in the Department of Ultrasonography in Nanjing General Hospital of Nanjing Military Command from January 2016 to March 2017.The patients were divided into CLNM group(n=83) and non-CLNM group (n =86).Analysis was made on the related risk factors of PTC CLNM.Results Multivariate logistic regression analysis showed that age(OR=0.211,95％CI:0.078～0.571,P=0.002),nodule size (OR=3.116,95％CI:1.498～6.482,P=0.002) and shape (OR=3.000,95％CI:1.301～6.913,P=0.010) were risk factors for CLNM in PTC(P＜0.05).The sensitivity rates of patient's age,nodule shape,module size,and microcalcification for predicting CLNM in PTC patients were 91％、79％、61％、75％ respectively.Conclusion For PTC patients less than 30 years old,ultrasonographic features with maximal diameter of nodule ＞ 1 cm,irregular shape,and microcalcification have a certain predictive value on CLNM and can be used as the basis for the selection of intraoperative cervical lymph node dissection.

Association between the ultrasonographic characteristics and cervical lymph metastasis in papillary thyroid carcinoma / 中华普通外科杂志

Objective To explore the correlation between the ultrasonographic characteristics and cervical lymph node metastasis in papillary thyroid carcinoma (PTC).Methods The clinical data of 320 PTC patients operated on from Oct 2014 to May 2016 were retrospectively reviewed.The correlation between age,sex,ultrasonographic characteristicsa and cervical lymph node metastasis was evaluated by multivariate analyses.Results Multivariate analysis showed that males,nodular size ＞ 1 cm,microcalcification,irregular nodule margin,multifocality were risk factors for cervical lymph node metastasis.ROC curve analysis demonstrated important significance,which was drawn according to thyroid imaging reporting and data system (TI-RADS) and nodular size,with the area under ROC curve being 0.792.Conclusion Males,nodular size ＞ 1 cm,microcalcification,irregular nodule margin,multifocality are important indexes predicting cervical lymph node metastasis in patients with PTC.

Relationship between Expression of Vascular Endothelial Growth Factor and Cervical Lymph Node Metastasis in Papillary Thyroid Cancer: A Meta-analysis / 华中科技大学学报（医学）（英德文版）

The aim of the present study was to examine the relationship between the protein expression of vascular endothelial growth factor (VEGF) and lymph node metastasis (LNM) in papillary thyroid cancer (PTC).VEGF-related articles that had been published until August 2016 were searched from the PubMed,EMBASE,and MEDLINE to identify the risk factors of LNM in PTC.RevMan 5.3 software was used for the meta-analysis.Finally,9 articles met the inclusion criteria and were included in our meta-analysis.LNM was found to be present in 176 of 318 patients (57.8％) with high VEGF expression and in 71 of 159 patients (47.0％) with low VEGF expression.The overall OR was 2.81 (95％ confidence interval,1.49-5.29).LNM occurred more frequently in patients with high VEGF expression than in those with low VEGF expression (P=0.001).Heterogeneity was markedly decreased in the subgroup analyses of LNM in terms of the patients' country of origin and the detection methods.Our meta-analysis concluded that the VEGF protein expression is associated with LNM in PTC.

A Case of Metastatic Hepatocellular Carcinoma Mimicking Acute Cervical Lymphadenitis / 대한이비인후과학회지

Hepatocellular carcinoma (HCC) is the most common cancer of the liver and the fifth most common cancer worldwide. The sites of extrahepatic metastasis are usually the lungs, adrenal gland, bone and brain via hematogeneous spreads. The lymphatic spread of HCC, mostly occurring at the regional abdominal lymph nodes, is relatively rare. Cervical lymph node metastasis of HCC is a very rare presentation, so that it is easily neglected in the clinic. In some cases, differential diagnosis between cervical lymphadenitis and lymph node metastasis can be challenging due to similar clinical features such as rapidly growing pattern, tenderness, fever and general ache. We report a case of left cervical lymphadenopathy diagnosed as HCC without prior diagnosis of HCC. A core-needle biopsy of left cervical lymphadenopathy demonstrated poorly differentiated unknown primary metastatic cancer. Positron emission tomography-computed tomography revealed the liver as the primary site of metastasis and the pathologic examination of liver biopsy specimen determined it to be HCC.

A clinical study of the characteristics of the cervical lymph node metastasis in patients with salivary gland adenoid cystic carcinoma / 中国肿瘤临床

Objective:Adenoid cystic carcinoma (ACC) is an uncommon malignant neoplasm, which mostly originates from the major and minor salivary glands of the head and neck region. This study aims to provide new information on head and neck ACC with cervical lymph node metastasis. Methods:Out of the 616 patients who underwent primary tumor resection from 1995 to 2008 in the authors' hospital, 62 cases with cervical lymph node metastasis were analyzed. Results:The general incidence rate of cervical lymph node me-tastasis in ACC was approximately 10%. The base of the tongue, mobile tongue, and mouth floor were the most frequent sites of lymph node metastasis with incidence rates of 19.2%, 17.6%, and 15.3%, respectively. Most cases exhibited the classictunnel-stylemetastatic pattern of occurrence, and the levelⅠb andⅡregions were the most frequently involved areas. Primary site and lympho-vascular invasions were significantly associated with lymph node metastasis. High patient mortality rate was also significantly correlat-ed with a high number of lymph node positive cases. Conclusion:Cervical lymph node metastasis has a high tendency of occurrence in the tongue-mouth floor complex, following the classictunnel-stylemetastatic pattern. Peritumoral lymphovascular invasion could be taken as a strong predictor for the occurrence of lymph node metastasis, which ultimately leads to poor prognosis of ACC patients. A selective neck dissection should be considered as a management in such patients.

Clinical and sonographic assessment of cervical lymph node metastasis in papillary thyroid carcinoma / 华中科技大学学报（医学）（英德文版）

The purpose of this study was to assess the differences in clinical and sonographic features of papillary thyroid carcinoma (PTC) between cervical lymph node metastatic (CLNM) and nonmetastatic groups. Clinical data of PTC patients (414 patients with 624 malignant nodules) who underwent a preoperative ultrasonography and surgery between June 2010 and March 2015 at Renmin Hospital of Wuhan University were retrospectively analyzed. Clinical factors, preoperative ultrasound features and the final pathological findings were obtained. The differences in the sonographic features of PTC between the CLNM group and the non-CLNM group were analyzed. There were 187 CLNM and 227 non-CLNM patients. The median age at the diagnosis of this cohort was 45.4 years old (ranging from 18 to 77 years). Ultrasonographic parameters that were significantly associated with CLNM [OR=2.569 (1.502, 4.393), P<0.001)] were as follows: the mulifocality of the nodules, size over 2 cm, the presence of microcalcifications, the distance ratio (DR) pattern showing the contact of the nodules with the thyroid capsule, and the extracapsular spread of the nodules. No significant differences in age, gender, thyroid stimulating hormone (TSH) levels and other ultrasonography parameters were found between the CLNM and the non-CLNM groups. Therefore, our results suggest that a larger size, microcalcifications, mulifocality, and the DR pattern showing the contact of the nodules with the thyroid capsule and extracapsular spread are significantly more indicative of CLNM in PTC.

Muscular invasion by oral squamous cell carcinoma of the posterior mandibular alveolar ridge is associated with cervical lymph node metastasis

OBJECTIVES: To assess the association between muscle invasion by oral squamous cell carcinoma of the posterior mandibular alveolar ridge and cervical lymph node metastasis on the basis of preoperative magnetic resonance imaging (MRI). MATERIALS AND METHODS: Twenty-six patients with oral squamous cell carcinoma of the posterior mandibular alveolar ridge were evaluated by MRI. The associations between cervical lymph node metastasis and independent factors evaluated by MRI were analyzed. Overall survival was also analyzed in this manner. Representative biopsy specimens were stained with anti-podoplanin and anti-CD34 antibodies. RESULTS: Mylohyoid muscle invasion was associated with cervical lymph node metastasis. A combinational factor of mylohyoid and/or buccinator muscle invasion was also associated with cervical lymph node metastasis. Cervical lymph node metastasis and masticator space invasion had a negative effect on overall survival. No lymphatic vessels were identified near the tumor invasion front within the mandible. In contrast, lymphatic vessels were identified near the front of tumor invasion in the muscles. CONCLUSION: This study demonstrates an association between muscular invasion by oral squamous cell carcinoma of the posterior mandibular alveolar ridge and cervical lymph node metastasis.

Clinical study of oral squamous cell carcinoma with clinically lymph node-negative / 实用口腔医学杂志

Objective:To investigate the clinical and pathological factors of metastasis in patients with oral squamous cell carcinoma (OSCC)and clinical lymph node-negative(cN0).Methods:85 patients of OSCC with cN0 treated in 2008-07 -2013-07 were inves-tigated retrospectively.Results:In the 85 patients 24(28.34%)showed occult metastasis.Patient's gender,lesion location had no im-pact to metastasis(P >0.05),the patient's age,tumor size,growth pattern and histopathologic grade showed significant influence on the metastasis of OSCC(P <0.05).Conclusion:The greater tumor volume,lower differentiation degree and young age are the factors of higher occult lymph node metastasis.Selective neck dissection treatments of OSCC is recommended.

Characteristics of ultrasound imaging of thyroid papillary carcinoma complicated with cervical lymph node tuberculosis / 吉林大学学报(医学版)

Objective To explore the ultrasound imaging characteristics of thyroid papillary carcinoma complicated cervical lymph node tuberculosis, and to elucidate the key points of ultrasound diagnosis and to distinguish with cervical lymph node metastasis of papillary thyroid carcinoma.Methods In total, 1 5 well-documented cases of papillary thyroid carcinoma diagnosed definitely were selected, and there were 6 cases of concomitant lymph node metastasis. The ultrasonography of lymph node enlargement was analyzed, and the differences of the ultrasonographic characteristics between lymph node tuberculosis and metastatic lymph node including the location, swelling, calcification, blood flow and regional nodal liquefaction. Results Thyroid papillary carcinoma complicated with cervical lymph node tuberculosis was often found in the areas of Ⅲ,Ⅳ and Ⅴ, especially in the area of Ⅴ. Variety of echo was mixed in tuberculous of lymph node, and the echo was inhomogenous. The tuberculosis of lymph node calcification was patchy inhomogeneous distribution.The echo in part of liquefaction of lymph node tuberculosis was cottony weak. The flow signal of tuberculous lymph appeared the surrounding or internal punctate distribution,and the soft tissue was echogenic and disorder around the lymph node tuberculosis. Conclusion When ultrasonography examination is performed in the patients with the thyroid papillary carcinoma complicated with cervical lymph node enlargement, the history should be considered to analyze the ultrasound characteristics to dignose by observing the lesions of the surrounding soft tissues.

Exploration of the relationship between ultrasonographic features of papillary thyroid carcinoma and lat-eral cervical lymph node metastasis / 实用肿瘤学杂志

Objective To investigate the relationship between ultrasonographic features of papillary thy-roid carcinoma(PTC)and lateral cervical lymph node metastasis (LCLNM).Methods A total of 449 eligible ca-ses with 633 PTC nodules was selected and divided into two groups:LCLNM group included 135 nodules(91 pa-tients);Without metastatic groups included 498 nodules(135 patients).Ultrasonographic features of PTC nodules and the relationship with LCLNM were analyzed by χ2 test and logistic regression analysis .Results In univariate analysis,the significant factors were male,age1 cm),multi-microcal-cificaltion(d<2 mm),mixed flow,wider than tall,CCLNM,extrathyroid extension,located in upper(P<0.05 or P<0.017).Multivariate analysis showed that multi -microcalcificaltion(d<2 mm),wider than tall,CCLNM,ex-trathyroid extension,located in upper pole were predictive factors of LCLNM (P<0.005,OR=1.626,2.644, 0.479,2.579).Conclusion High-frequency ultrasound can accurately describe the sonographic appearance of thyroid nodules;it can be used to remind the risk of LCLNM before operation ,and will be informative for the treat-ment of surgery .

Pre-operative contrast enhanced computer tomographic evaluation of cervical nodal metastatic disease in oral squamous cell carcinoma.

Aims: This prospective study was undertaken to evaluate the contrast enhanced computed tomography (CECT) criteria in detecting cervical lymph node metastasis in 50 patients with an oral squamous cell carcinoma (OSQCC). Materials and Methods: A total of 50 patients with OSQCC who underwent clinical assessment, routine CECT scanning of cervical lymph node and radical neck dissection were analyzed. Radiologic criteria for diagnosing nodal metastasis in this imaging study were: A nodal size of 1 cm, the presence of central lucency despite the size of the lymph node and grouping of lymph nodes. These criteria were based on modified American Joint Committee on Cancer Radiological Nodal Staging Guidelines. Statistical Analysis: Chi-square test/Fisher Exact test has been used to find the significant association of findings. Diagnostic statistics viz.: Sensitivity, specificity, positive predictive value (PPV), negative predictive value, and diagnostic accuracy were obtained. The results were considered significant when P value was less than 0.05. Results: On using a nodal size of 1 cm and the presence of central nodal necrosis (CNN) as radiological criteria for nodal metastasis CT scanning staged 23 of the 27 histopathologically positive necks, providing accuracy of 88%, sensitivity of 92%, and specificity of 84% in detection of nodal metastasis. A significant relationship between the incidence of CNN, different nodal densities, and primary tumor differentiation was observed. Conclusions: The nodal size cut-off of 1-1.5 cm had a maximal sensitivity of 90.91% and PPV of 86.96%. Furthermore, observation of nodal densities in the absence of frank CNN on the CT scan may be necessary especially in low grade primary tumor. CT assessment of cervical node metastasis was found acceptable, although adjuncts like ultrasound guided fine needle aspiration may further increase efficacy of CT scan in nodes lesser than 1 cm in size.

Clinical analysis of the characteristics of cervical lymph node metastasis in thoracic esophageal squamous cell carcinoma / 中国癌症杂志

Background and purpose: Lymph node (LN) metastasis of esophageal cancer of neck rate higher, but there is little bulk reports. This article aimed to analyze the characteristics of cervical lymph node metastasis (CLN) in thoracic esophageal squamous cell carcinoma (TE-SCC) and the clinical role. Methods:A total number of 1 131 TE-SCC patients underwent radical esophagectomy plus three-ifeld lymph node dissection at Fujian Provincial Tumor Hospital between Jan. 1993 to Dec. 2003, during which, 367 patients had pathological metastasis of CLN. Results:The metastatic rate of CLN was 33.2%for the entire group, 43.7%, 33.0%and 16.0%for the upper, middle and lower TE-SCC respectively. Single factor analysis showed that the metastatic rate of CLN was relevant with the tumor site, pathological differentiated degree, lesion length showed in X-ray, pT stage and the number of CLN (P<0.05). But multivariate regression analysis showed that the metastatic rate of CLN was just relevant with the tumor site, pT stage and the number of CLN (P<0.05). Metastasis of cervical paraesophageal lymph nodes was the most common, and Background and purpose: Lymph node (LN) metastasis of esophageal cancer of neck rate higher, but there is little bulk reports. This article aimed to analyze the characteristics of cervical lymph node metastasis (CLN) in thoracic esophageal squamous cell carcinoma (TE-SCC) and the clinical role. Methods:A total number of 1 131 TE-SCC patients underwent radical esophagectomy plus three-ifeld lymph node dissection at Fujian Provincial Tumor Hospital between Jan. 1993 to Dec. 2003, during which, 367 patients had pathological metastasis of CLN. Results:The metastatic rate of CLN was 33.2%for the entire group, 43.7%, 33.0%and 16.0%for the upper, middle and lower TE-SCC respectively. Single factor analysis showed that the metastatic rate of CLN was relevant with the tumor site, pathological differentiated degree, lesion length showed in X-ray, pT stage and the number of CLN (P<0.05). But multivariate regression analysis showed that the metastatic rate of CLN was just relevant with the tumor site, pT stage and the number of CLN (P<0.05). Metastasis of cervical paraesophageal lymph nodes was the most common, and supraclavicular lymph node metastasis was next, and metastasis of cervical profound lymph nodes and retropharyngeal lymph nodes were rare. The ratio of the number of CLN occupied the sum of the segmental CLN were 57.7%, 32.0%and 10.0%for the upper, middle and lower TE-SCC respectively (P<0.05). Right CLN of each segmental TE-SCC was more than left CLN. Conclusion:Independent factors on CLN in TE-SCC are the tumor site, pT stage and the number of CLN. Metastasis of cervical paraesophageal lymph nodes is the most common, and supraclavicular lymph node metastasis is next, and metastasis of cervical profound lymph nodes and retropharyngeal lymph nodes are rare.

Predictors of Lateral Lymph Node Metastasis in Papillary Thyroid Microcarcinoma: A Retrospective Review / 대한내분비외과학회지

PURPOSE: Cervical lymph node metastasis in patients with papillary thyroid microcarcinoma (PTMC) is associated with an increased recurrence rate and distant metastases. In this study, we analyzed the predictive factors of lateral metastasis in patients with PTMC. METHODS: We retrospectively reviewed the medical records of 1,030 patients with PTMC who underwent thyroidectomy. The clinicopathological characteristics and radiological findings upon ultrasonography (US) and computed tomography (CT) were then analyzed to evaluate the predictability of lateral metastasis of PTMC. RESULTS: The overall rate of lateral metastasis was 3.3% for the 1,030 patients with PTMC. All patients underwent central lymph node dissection (CLND), and 119 of these patients (11.6%) underwent either prophylactic or therapeutic selective neck dissection (SND). Among patients who underwent lateral node evaluation, 28.6% had lateral metastasis. We found that lateral metastasis was associated with larger tumor size, extrathyroidal extension, multiple tumors, bilateral tumors, CLN metastasis, and positive expression of thyroid peroxidase. Positive findings of CLN and lateral metastases on ultrasonography (US) and computed tomography (CT) were significantly associated with lateral metastasis. CONCLUSION: This study demonstrated that, for patients with PTMC, larger tumor size, extrathyroidal extension, multiple tumors, bilateral tumors, CLN metastasis, positive expression of thyroid peroxidase, and positive CLN and lateral metastases identified on US and CT were significantly associated with lateral metastasis. Further studies with a large prospective study and longer follow-up are needed to clarify the predictive value of these factors.