Clinical characteristics and dissection value of central lymph node metastasis of papillary thyroid microcarcinoma / 局解手术学杂志

ABSTRACT

Objective To explore the related risk factors of central lymph node metastasis ( CLNM) of papillary thyroid microcarcinoma ( PTMC) and the application value of central lymph node dissection ( CLND) . Methods Totally 251 patients who were confirmed as PTMC by pathological biopsy were selected as the research object, and they were divided into the metastasis group (n=42) and the non-metastasis group (n=209) according to the status of lymph node metastasis. The general datum of the two groups were retrospectively analyzed, and the indexes with significant differences after univariate analysis were analyzed by non-conditional Logistic regression analysis. Treated the patients with lymph node metastasis through CLND, and the occurrence rate and recurrence rate of related complications were recorded during the 1 to 3 years of follow-up. Results The comparison of the location of the tumor, complicated adenoma, Hashimoto’ s thyroiditis, nodular goiter, and hyperthyroidism between the two groups was not statistically significant (P>0. 05). In the metastasis group, the rate of patients aged less than 45 years old and the percentage of male patients were both significantly higher than the non-metastasis group, and the difference was of statistical significance (P<0. 05). There were 25 cases (59. 5%) whose tumor diameter were 5~10 mm, 12 cases (28. 6%) with multiple lesions, and 22 cases (52. 4%) breaking through the envelope in the metastasis group, which were significantly higher than 70 cases (33. 5%), 23 cases (11. 0%) and 67 cases (32. 1%) in the non-metastasis group, and the differences were statistically significant (P<0. 05). In the metastasis group after operation, there was 1 cases (2. 3%) of hoarseness, 6 cases (14. 3%) of local numbness, 1 case (2. 3%) of nerve invasion, and 2 cases (4. 8%) of vascular invasion, and there was no choking cough report. During the period of 1 to 3 years of follow-up, there were only 2 cases of recurrence and the recurrence rate was 4. 8%. Conclusion Central lymph node metastasis mostly occurs in the male patients with PTMC who are less than 45 years old. And the main characteristics are diameter of tumor over 5 mm, multifocal lesions, with envelope penetration symptom and so on. In clinic, patients who meet the above-mentioned condition should be taken as the primary concern and given related prevention measures to reduce the occurrence risk of central lymph node metastasis. To treat patients with papillary thyroid microcarcinoma through central lymph node dissection can receive good curative effect and effectively improve the prog-nosis quality, and it is worthy of clinical promotion.