Clinical value of Delphian lymph node in papillary thyroid carcinoma / 国际外科学杂志

ABSTRACT

Objective To study the correlations between DLN and clinical pathological factors and provide clinical data for assessing the operation scopes and prognostic evaluations aims at further clarify its clinical values.Methods The research aimed at the 69 cases who undertook first-time surgery and confirmed thyroid papillary carcinoma by intraoperative frozen pathology from 2013 to 2014 in Wannan Medical college affiliated Yijishan Hospital.The groups was divided by whether the DLN had been detected and metastasized.And we made chi-square test or t test by using SPSS 22.0 to analysis between the clinical and pathological factors.Results The groups was divided by whether DLN had been metastasized from the detected cases and the results shown that there was no relationship with gender,age,tumor size,Hashimoto's thyroiditis and the number of COLN (which not including DLN).For multifocal cases (21.05％ vs 57.14％,P =0.047);for vascular infiltration,the positive cases of (10.53％ vs 71.43％,P＜0.001);for the metastasized rate of COLN,the positive cases of (65.79％ vs 14.29％,P =0.011);for the metastasized number of COLN,[(0.84 ± 1.48) vs (3.86 ± 3.08),P ＜ 0.001].All the data above illustrated that the two groups are statistically correlative in mulifocality,vascular infiltration,the metastasized rate of COLN and for the metastasized number of COLN.17.39％ of PTC cases can be detected by CD34 and D2-40.According to the presence of vascular infiltration,it can be divided into two groups,We contrast analyzed of the number of TCLN (include DLN),metastasized number of TCLN and the metastasized rate of TCLN.The results shown that the number of TCLN had no statistical differences,but significant in metastasized number of TCLN [(0.74 ± 1.83) vs (4.50 ± 2.20),P ＜ 0.001) and the metastasized rate of TCLN (29.82％ vs 100.00％,P ＜ 0.01)].Conclusions The DLN positive patients are more likely to have distant lymph node metastasized.If DLN positive,total thyroidectomy and bilateral central compartment neck dissection (CCND) has been necessary.Lateral selective neck node dissection (LSND) can be underwent after evaluating carefully combining with the history and preoperative images.CD34 and D2-40 could be the detection indexes of vascular infiltration for PTC.For the cases with vascular infiltration,it has a higher proportion to have the metastasized number and metastasized rate of TCLN and higher possibility of distant metastasis.So we should expand the scope of operation moderately and strengthen postoperative follow-up according to the history and preoperative images so as to reduce postoperative recurrence,distant metastasis rate and improve the living quality of patients.