高级搜索

甲状腺乳头状微小癌临床病理分析及术中中央区淋巴结清扫的探讨

杨映红, 连渊娥, 赵文新, 冯昌银

杨映红, 连渊娥, 赵文新, 冯昌银. 甲状腺乳头状微小癌临床病理分析及术中中央区淋巴结清扫的探讨[J]. 肿瘤防治研究, 2013, 40(09): 856-859. DOI: 10.3971/j.issn.1000-8578.2013.09.009
引用本文: 杨映红, 连渊娥, 赵文新, 冯昌银. 甲状腺乳头状微小癌临床病理分析及术中中央区淋巴结清扫的探讨[J]. 肿瘤防治研究, 2013, 40(09): 856-859. DOI: 10.3971/j.issn.1000-8578.2013.09.009
YANG Yinghong, LIAN Yuan'e, ZHAO Wenxin, FENG Changyin. A Study on Clinicopathology of Papillary Thyroid Microcarcinoma and Central Lymph Node Dissection during Operation[J]. Cancer Research on Prevention and Treatment, 2013, 40(09): 856-859. DOI: 10.3971/j.issn.1000-8578.2013.09.009
Citation: YANG Yinghong, LIAN Yuan'e, ZHAO Wenxin, FENG Changyin. A Study on Clinicopathology of Papillary Thyroid Microcarcinoma and Central Lymph Node Dissection during Operation[J]. Cancer Research on Prevention and Treatment, 2013, 40(09): 856-859. DOI: 10.3971/j.issn.1000-8578.2013.09.009

甲状腺乳头状微小癌临床病理分析及术中中央区淋巴结清扫的探讨

详细信息
    作者简介:

    杨映红(1969-),女,本科,主任医师,主要从事肿瘤病理的研究

    通讯作者:

    赵文新,E-mail:fzhzwx6688@163.com

  • 中图分类号: R736.1

A Study on Clinicopathology of Papillary Thyroid Microcarcinoma and Central Lymph Node Dissection during Operation

  • 摘要: 目的 分析甲状腺乳头状微小癌(PTMC)的临床病理因素,探讨术中中央区淋巴结清扫的病理诊断方法。 方法 复习存档病理资料125例PTMC(2010年),详细描述其组织学诊断标准,并与近3年来PTMC病理资料作比较。 结果 微小乳头状癌以女性患者居多,共107例,占85.6%(男女比例为1∶6);≤45岁58例(46.4%),>45岁64例(51.2%),差异无统计学意义;左侧49例(39.38%),右侧63例(50.4%),双侧12例(9.6%),峡部1例。术中冰冻切片检查121例,未做4例,确诊113例(88.43%),冰冻切片漏诊8例(6.6%)。确诊病例中92例做了同侧中央区淋巴结清扫,淋巴结出现转移28例(30.44%),无转移64例(69.7%)。其中原发灶≥0.5 cm者中央区淋巴结转移率为34.0% (18/53),<0.5 cm者转移率为25.6% (10/39),两者比例为1.71∶1,但差异无统计学意义(P=0.391)。 结论 术中冰冻切片确诊为PTMC者应行预防性中央区淋巴结清扫。

     

    Abstract: Objective To study clinicopathology of papillary thyroid microcarcinoma (PTMC) and how to dissect the central compartment lymph node during operation. Methods The clinicopathologic data of 125 cases with PTMC(in 2010) were reviewed and the diagnostic criterion of PTMC were analyzed. Pathological data of PTMC among recent 3 years were compared. Results In 125 patients of PTMC, 17 was males(13.6%),107 females(85.6%) and 1 unrecorded. 64 cases(51.2%) were more than 45ys and 58 cases(46.4%) were less than 45ys. The cancer locations were as follows: left side 49 cases(39.4%), right side 63 cases (50.4%), bilateral 12 cases(9.6%), and isthmus 1 cases. The frozen section during operation was performed in 121 cases. The right diagnosis was observed in 113 cases (accuracy rate 93.4%), and missed diagnosis in 8 cases (error rate 6.6%). Ninty-two cases had ipsilateral compartment lymph node dissection, of whom, 28 cases were found lymph node metastasis(30.4%). Among the PTMC cases, patients with the primary lesion ≥0.5 cm had slightly higher central node metastasis, compared with those with lesion <0.5 cm,34.0% (18/53) vs.25.6%(10/39), P=0.391. Conclusion A prophylactic dissection of central compartment lymph nodes should be performed to PTMC diagnosed by intraoperative frozen section.

     

  • [1] Wang Yu,Ji QH,Huang CP,et al.Predictive factors for level VI lymph node metastasis in papillary thyroid microcarcinoma[J].Zhonghua Wai Ke Za Zhi,2008, 46(24):1899-901.[王宇, 嵇庆海,黄彩平,等. 甲状腺乳头状微癌Ⅵ区淋巴结转移相关因素分析[J]. 中华外科杂志, 2008, 46(24):1899-901.]
    [2] Li XL,Gao M,Zhen XQ,et al.Clinical and biological characteristics of papillary thyroid microcarcinoma[J].Zhongguo Zhong  Liu Lin Chuang,2008, 35(23):1325-7.[李小龙,高明,郑向前等. 甲状腺乳头状微小癌的临床生物学特性研究[J].中国肿瘤临床,2008,35(23):1325-7.]
    [3] Gao M, Li XL,Gao SY,et al.The clinical biocharacteristics of different histopathological variants in patients of papillary thyroid carcinoma[J].Zhonghua Pu Tong Wai Ke Za Zhi,2006,21(8):588-90.[高明,李小龙,高松源,等. 甲状腺乳头状癌组织学变型的临床生物学特性[J].中华普通外科杂志,2006,21(8):588-90.]
    [4] Beesley MF,McLaren KM.Cytokeratin 19 and galectin-3 immunohistochemistry in the differential diagnosis of solitary thyroid nodules [J].Histopathology,2002,41(3):236-43.
    [5] Tong J,Wang Y,Da JP,et al. Usefulness of CK19,HBME-1and Galectin-3 expressions in differential diagnosis of thyroid papillary microcarcinoma from benign lesions[J].Zhonghua Zhong Liu Za Zhi, 2011, 33(8):599-604.[佟杰,王岩,笪冀平,等.CK19 HBME-1 Galectin-3 等表达在甲状腺乳头状微小癌与良性病变鉴别诊断中的意义[J].中华肿瘤杂志,2011, 33(8):599-604.]
    [6] Sugitani I,Kasai N,Fujimoto Y,et al.A novel classification system for patients with PTC:addition of the new variables of large (3cm or greater) nodal metastases and reclassification during the follow-up period[J].Surgery,2004,135(2):139-48.
    [7] 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[J].Langerbecks Arch Surg,1998,383(2):167-9.
    [8] Kim HY,Park WY,Lee KE, et al. Comparative analysis of gene expression profiles of papillary thyroid microcarcinoma and papillary carcinoma[J]. J Cancer Res Ther,2010,6(4):452-7.
    [9] Lee J,Rhee Y,Lee S,et al.Frequent, aggressive behaviors of thyroid microcarcinoma in Korean patients[J].Endocr J,2006,53(5):627-32.
    [10] Chow SM,Law SC,Chan JK,et al.Papillary microcarcinoma of the thyroid-prognostic signficance of lymph node metastasis and multifocality[J].Cancer,2003,98(1):31-40.
    [11] Shao Y,Cai XJ,Gao L,et al. Clinical factors related to central compartment lymph node metastasis in papillary thyroid microcarcinoma:clinical analysis of 117 cases[J].Zhonghua Yi Xue Za Zhi,2009,89(6):403-5.[邵雁,蔡秀军,高力,等. 甲状腺微小乳头状癌中央区淋巴结转移及临床因素分析[J]. 中华医学杂志,2009,89(6):403-5.]
    [12] Sun CZ,Chen FJ,Zeng ZY,et al.Treatment and prognosis of papillary thyroid microcarcinoma[J]. Zhonghua Pu Tong Wai Ke Za Zhi,2011,26 (4):283-5.[孙传政,陈福进,曾宗渊,等.甲状腺乳头状微小癌124例的治疗和预后分析[J]. 中华普通外科杂志,2011,26(4):283-5.]
计量
  • 文章访问数:  1572
  • HTML全文浏览量:  29
  • PDF下载量:  453
  • 被引次数: 0
出版历程
  • 收稿日期:  2012-08-19
  • 修回日期:  2013-02-15
  • 刊出日期:  2013-09-24

目录

    /

    返回文章
    返回
    x 关闭 永久关闭