ObjectiveTo investigate the predictive value of pretracheal lymph node (Ⅵc) subdivision for contralateral central lymph node (CLN) metastasis in clinical lymph node negative (cN0) unilateral papillary thyroid carcinoma (PTC). MethodsThe data of patients with cN0 unilateral PTC who initially underwent total thyroidectomy and bilateral CLN dissection in the Department of Thyroid Surgery of West China Hospital, Sichuan University from July 2017 to June 2021 were collected retrospectively. The Ⅵc subdivision was divided into right anterior trachea (Ⅵc1) and left anterior trachea (Ⅵc2); If the lymph nodes crossed the middle line of trachea, which would be included in the side of cancer focus. ResultsA total of 175 patients were included in this study, and the incidences of lymph nodes metastasis in the prelaryngeal (Ⅵd), Ⅵc, ipsilateral Ⅵc, contralateral Ⅵc, ipsilateral central, and contralateral central regions were 54 cases (30.9%), 118 cases (67.4%), 85 cases (48.6%), 72 cases (41.1%), 108 cases (61.7%), and 43 cases (24.6%), respectively. The results of the univariate analysis found that the contralateral CLN metastasis was associated with the lymph node metastases of Ⅵd, Ⅵc, contralateral Ⅵc, and ipsilateral central regions; The results of the multivariate analysis found that the lymph node metastases of Ⅵd and contralateral Ⅵc regions increased the probability of contralateral CLN metastasis (OR=4.444, P<0.001; OR=6.655, P=0.001). ConclusionsFrom the results of the study,Ⅵc subdivision is reasonable and effective, and has a certain predictive value for the metastasis of contralateral CLN in cN0 unilateral papillary thyroid carcinoma. And bilateral CLN dissection should be recommended in patients with a positive intraoperative frozen section result of contralateral pretracheal lymph node metastasis.
ObjectiveTo evaluate the safty of recurrent laryngeal nerve (RLN) and parathyroid if Pseudomonas aeruginosa injection (PAI) is used after total thyroidectomy and central neck dissection (CND).MethodsFrom Mar. 2016 to Oct. 2017, we recruited 113 patients with papillary thyroid cancer (PTC) who accepted total thyroidectomy and CND. During operation, 1 mL of PAI was applied in 58 patients (local spray group) and 55 not (control group). The hoarseness, hypoparathyroidism, chylous fistula, drainage volume, hospital stay, and incidence of complications were compared between the two groups.ResultsThe two groups embraced few difference in age, gender, BMI, tumor site, the diameter of tumor and the number of metastatic and the harvested lymph nodes (P>0.05). There were nobody who has suffered in hoarseness and permanent hypoparathyroidism in both groups at any time after operation. There was no significant differences of complication between the two groups. The drainage volume at 24 h after operation in the local spraying group was more than that in the control group, and the difference was statistically significant (P=0.023). There were 2 patients had chylous fistula after surgery in the control group but none in the local spray group. The total volumes of drainage, incidence of fever and incision infection, the mean stay in the hospital, and the postoperative pain score had no statistic significance in the both groups.ConclusionAfter total thyroidectomy and CND, local spraying of PAI in the wound cavity is safe and will not damage the recurrent laryngeal nerve.
ObjectiveTo investigate the risk factors for central lymph node metastasis (CLNM) in patients with clinically negative lymph node (cN0 stage) papillary thyroid carcinoma (PTC).MethodsThe clinicopathological data of 250 patients with cN0 PTC who underwent thyroidectomy and central lymph node dissection (CLND) in Department of General Surgery of Xuzhou Central Hospital from June 2016 to June 2019 were retrospectively analyzed. The influencing factors of CLNM in patients with cN0 PTC were analyzed by univariate analysis and binary logistic regression, and then R software was used to establish a nomogram prediction model, receiver operating characteristic curve was used to evaluate the differentiation degree of the model, and Bootstrap method was used for internal verification to evaluate the calibration degree of the model.ResultsCLNM occurred in 147 of 250 patients with cN0 PTC, with an incidence of 58.8%. Univariate analysis showed that multifocal, bilateral, tumor diameter, and age were correlated with CLNM (P<0.01). The results of binary logistic regression analysis showed that multifocal, bilateral tumors, age≥45 years old, and tumor diameter>1 cm were independent risk factors for CLNM in patients with cN0 PTC (P<0.05). The area under the curve (AUC) of the nomogram prediction model established on this basis was 0.738, and the calibration prediction curve in the calibration diagram fitted well with the ideal curve.ConclusionsCLNM is more likely to occur in PTC. The nomogram model constructed in this study can be used as an auxiliary means to predict CLNM in clinical practice.
ObjectiveTo investigate the risk factors affecting cervical central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM) in patients with papillary thyroid carcinoma (PTC). MethodsThe patients with newly diagnosed with PTC who underwent surgical treatment in this hospital from April 2020 to December 2023 were included. The univariate and multivariate logistic regression analyses were conducted to identify the risk factors affecting the occurrences of CLNM and LLNM in patients with PTC and a prediction model was developed using these risk factors. Additionally, the discriminatory power of the predictive model for CLNM or LLNM was evaluated using the area under the receiver operating characteristic curve (AUC). ResultsA total of 297 patients with PTC were included in this study, among whom 149 (50.2%) cases developed CLNM, and 41 (13.8%) cases developed LLNM. The multivariate analysis indicated that the male, age <36 years old, and maximum tumor diameter >5 mm were the independent risk factors for CLNM in the patients with PTC (P<0.05). The independent risk factors for LLNM in the patients with PTC were the age ≥59 years old, bilateral or isthmus distribution of cancer foci, maximum tumor diameter >5 mm, and invasion of capsule (P<0.05). The AUC (95%CI) of the CLNM prediction model, constructed using three risk factors (gender, age, and maximum tumor diameter), was 0.693 (0.633, 0.752). For the LLNM prediction model, which incorporated four factors [age, distribution of cancer foci, maximum tumor diameter, and capsular invasion], the AUC (95%CI) was 0.776 (0.707, 0.846). ConclusionsThe findings of this study suggest that younger male patients with PTC (age <36 years), and a maximum tumor diameter >5 mm have a higher risk of CLNM. However, the predictive model constructed for CLNM demonstrates only moderate discriminatory power. In contrast, elderly patients (age ≥59 years old) with PTC exhibiting a maximum tumor diameter >5 mm, capsular invasion, and bilateral (or isthmus) lesions are at greater risk of LLNM. The predictive model developed for LLNM shows a certain discriminatory performance.
Objective To explore the risk factors the central cervical lymph node micrometastasis of papillary thyroid microcarcinoma (PTMC). Methods PTMC patients who underwent surgical operations in West China Hospital, Sichuan University between January 2014 and December 2018 were retrospectively enrolled. The patient did not find lymph node metastasis in the central cervical area by preoperative ultrasound. During the operation, the central cervical lymph node of the affected side was dissected or lymph node dissection in the central area of the affected side of the neck plus the lateral area of the neck. With postoperative pathology as the gold standard, patients were divided into central cervical lymph node micrometastasis group (micrometastasis group) and central cervical lymph node non-metastasis group (non-metastasis group). The differences of clinical features and ultrasonic signs between the two groups were analyzed. Results A total of 507 patients were included, including 223 (44.0%) in the micrometastasis group and 284(56.0%) in the non-metastasis group. The results of univariate analysis showed that compared with the non-metastasis group, the patients in the micrometastasis group were younger, the tumor size were higher, the proportion of male, multifocality, bilateral involvement and thyroid capsular invasion were higher. The results of multiple logistic regression analysis showed that lower age [odds radio (OR)=0.967, 95% confidence interval (CI)(0.949, 0.985), P<0.001], male [OR=2.357, 95%CI (1.503, 3.694), P<0.001)], a larger maximum diameter of PTMC [OR=1.232, 95%CI (1.100, 1.379), P<0.001], a larger nodule volume of PTMC [OR=1.031, 95%CI (1.008, 1.114), P=0.032], multifocal lesion [OR=2.309, 95%CI (1.167, 4.570), P=0.016] and invasion of the thyroid capsule [OR=1.520, 95%CI (1.010, 2.286), P=0.045] were independent risk factors for central cervical lymph node micrometastasis. Conclusions The patient’s male, young age, PTMC nodule with large maximum diameter and large volume, multifocal, and invasion of the thyroid membrane are risk factors for the central cervical lymph node micrometastasis of PMTC patients. These clinical and ultrasound signs can provide a theoretical basis for doctors’ clinical management decisions.
ObjectiveTo systematically evaluate effectiveness and safety of total thyroidectomy(TT) plus prophylactic central neck dissection(PCND) versus TT for stage cN0 papillary thyroid carcinoma(PTC). MethodsDatabases including PubMed, EMbase, The Cochrane Library(Issue1, 2015), WanFang Data, CBM, and CNKI were searched to collect the randomized controlled trails(RCTs) and non-RCTs about TT+PCND versus TT for stage cN0 PTC. The retrieval time was from inception to March 2015. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality was evaluated independently by 2 reviewers. Then the meta-analysis was conducted using RevMan 5.1 software. ResultsA total of 10 non-RCTs involving 3 661 patients were included. There were 1 774 cases in the TT+PCND group and 1 887 cases in the TT group. The results of meta-analysis showed that: Related to postoperative complications, compared with TT group, the postoperative transient hypocalcemia rate〔OR=0.40, 95% CI(0.33, 0.49), P < 0.000 01〕and permanent hypocalcemia rate were higher〔OR=0.32, 95% CI(0.19, 0.55), P < 0.000 1〕, the recurrence rate was lower〔OR=1.51, 95% CI(1.07, 2.13), P=0.02〕in the TT+PCND group. But there were no differences in the transient laryngeal nerve palsy rate〔OR=0.73, 95% CI(0.49, 1.09), P=0.13〕and permanent laryngeal nerve palsy rate〔OR=0.87, 95% CI(0.50, 1.52), P=0.62〕between the 2 groups. ConclusionsTT+PCND is superior to TT in treating stage cN0 PTC for it's lower recurrence, but it is raising transient hypocalcemia and permanent hypocalcemia rate at the same time. And it is similar as TT in transient laryngeal nerve palsy and permanent laryngeal nerve palsy rate. So TT+PCND is safe and feasible for treating stage cN0 PTC when its indications are strictly controlled. However, for the quantity and quality limitation of the included studies, this conclusion still requires to be further proved by performing large scale and high quality RCTs. It suggests that doctors should choose a best therapy for stage cN0 PTC patients according to an integrative disease assessment.
ObjectiveTo investigate the effect of lymph node dissection in central region on the prognosis of cN0 papillary thyroid microcarcinoma (PTMC).MethodsAccording to the inclusion and exclusion criteria, 300 patients with cN0 PTMC underwent operation in the Second Department of General Surgery of Zhongshan People’s Hospital from January 1, 2007 to May 31, 2016 were retrospectively collected, then who were divided into the central lymph node non-dissection (147 cases) and dissection (153 cases) groups according to whether central lymph node dissection or not. The differences in the incidence of postoperative complications, recurrence rate, and metastasis rate between the two groups were analyzed. The risk factors of central lymph node metastasis of cN0 PTMC were analyzed.ResultsAll patients had no postoperative lymphatic leakage and death. Fifty-nine (38.6%) cases had the lymph node metastasis in the patients with central lymph node dissection. The patients were followed up for (83.0±20.7) months and (79.5±26.2) months (t=1.283, P=0.203) of the non-dissection group (147 cases) and dissection group (153 cases), respectively. During the follow-up period, there was no distant metastasis such as bone metastasis and lung metastasis in both groups; 5 cases recurred in the non-dissection group, 1 case recurred in the dissection group, and there was no significant difference in the recurrence rate between the two groups (χ2=3.008, P=0.089). There was no permanent complications between the two groups. There was no significant difference in the disease-free survival curve (χ2=2.565, P=0.109) between the two groups. The incidence of capsule invasion (P=0.026), calcification (P<0.001), hoarseness (P=0.013), numbness of limbs (P<0.001) in the dissection group were significantly higher than those in the non-dissection group. The results of multivariate analysis showed that the multifocal (OR=24.57, P<0.001), tumor diameter >5 mm (OR=5.46, P=0.019), and capsule invasion (OR=9.42, P=0.002) were the independent risk factors for the lymph node metastasis in the central region.ConclusionsFrom the results of the study, thyroidectomy alone is safe for cN0 PTMC, but the changes of lymph nodes in the central region still need more long-term follow-up. cN0 PTMC patients with tumor diameter >5 mm, multifocal, and capsule invasion are more likely to have lymph node metastasis in the central region. Comprehensive evaluation can be made according to the patient’s condition, and individualized and precise treatment can be carried out.
Objective To investigate the value of sentinel lymph node biopsy (SLNB) in predicting the metastasis of central cervical lymph nodes (CCLN) in differentiated thyroid carcinoma, and to explore reasonable program for CCLN dissection. Methods This retrospective analysis was performed basing on the clinical data of 407 patients with differentiated thyroid carcinoma who were admitted to the Department of General Surgery of Xuanwu Hospital from June 2013 to December 2016, including 237 patients with microcarcinoma. Results ① The results of the lymph nodes detection. All patients had detected 7 766 lymph nodes (1 238 metastatic lymph nodes were detected from 219 patients), and 2 085 sentinel lymph nodes were detected (448 metastatic sentinel lymph nodes were detected from 189 patients). In the patients with microcarcinoma, there were 3 614 lymph nodes were detected (390 metastatic lymph nodes were detected from 97 patients), and 1 202 sentinel lymph nodes were detected (149 metastatic sentinel lymph nodes were detected from 82 patients). ② The value of SLNB to predict CCLN metastasis. The sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of SLNB to predict CCLN metastasis for all patients was 86.30% (189/219), 100% (188/188), 0 (0/189), 13.70% (30/219), 100% (189/189), and 86.24% (188/218) respectively; for patients with microcarcinoma was 84.54% (82/97), 100% (140/140), 0 (0/82), 15.46% (15/97), 100% (82/82), and 90.32% (140/155), respectively. ③ The value of SLNB to predict the presence of additional positive lymph nodes (APLN). The sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of SLNB to predict the APLN for all patients was 81.48% (132/162), 76.73% (188/245), 23.27% (57/245), 18.52% (30/162), 69.84% (132/189) and 86.24% (188/218), respectively; for patients with microcarcinoma was 73.68% (42/57), 77.78% (140/180), 22.22% (40/180), 26.32% (15/57), 51.22% (42/82) and 90.32% (140/155) respectively. ④ The value of positive sentinel lymph node ratio (PSLNR) to predict the presence of the APLN. The sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of PSLNR to predict the APLN for all patients was 71.97%, 78.95%, 21.05%, 28.03%, 88.79%, and 54.88% respectively, and the cutoff for PSLNR was 0.345 2. For patients with microcarcinoma, the sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of PSLNR to predict the APLN was 83.33%, 67.50%, 32.50%, 16.67%, 72.92%, and 79.41% respectively, and the cutoff for PSLNR was 0.291 7. Conclusion There is an important predicted value of SLNB for CCLN dissection in the patients suffered from differentiated thyroid carcinoma, and the PSLNR is a reliable basis for CCLN dissection.
ObjectiveTo investigate the value of central lymph node dissection in patients with cN0 papillary thyroid carcinoma. MethodThe clinical data of 128 patients with cN0 papillary thyroid carcinoma who had been performed central lymph node dissection during their hospitalization from December 2010 to July 2012 in Chinese PLA General Hospital were analyzed retrospectively. ResultsThe central neck lymph node metastasis rate was 35.94%(46/128) in 128 patients with cN0 papillary thyroid carcinoma, which in the patients with aged less than 45 years, with the tumor diameter larger than 1 cm, and with capsule or extrathyroidal invasion were significantly higher than those in the patients with aged larger than 45 years, with the tumor diameter less than 1 cm, and without capsule or extrathyroidal invasion (P < 0.05). After the operation, there were 22(17.19%) patients with temporary hypoparathyroidism as well as 3(2.34%) patients with temporary recurrent laryngeal nerve injury. However, no permanent recurrent laryngeal nerve injury and permanent hypoparathyroidism occurred. During the 14-32 months follow-up with an average 23.4 months, 2 cases of lateral neck lymph node metastases were observed. ConclusionAs an essential, effective, and safe operation to the patients with cN0 papillary thyroid carcinoma, central lymph node dissection should be performed by experienced hands.