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首页> 外文期刊>The Laryngoscope: A Medical Journal for Clinical and Research Contributions in Otolaryngology, Head and Neck Medicine and Surgery, Facial Plastic and Reconstructive Surgery .. >Papillary thyroid cancer: controversies in the management of neck metastasis.
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Papillary thyroid cancer: controversies in the management of neck metastasis.

机译：甲状腺乳头状癌：颈部转移管理中的争议。

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OBJECTIVE/HYPOTHESIS: To describe our institution's experience with the management of cervical metastasis in papillary thyroid carcinoma (PTC) and suggest a treatment strategy based on the incidence of pathologic nodes and cervical recurrence in patients undergoing varied surgical approaches to address lymphadenopathy over the study dates. MATERIALS AND METHODS: Between December 1, 1972 and September 1, 2007, 183 total patients diagnosed with PTC at the University of Pittsburgh Medical Center were treated with lymphadenectomy. Pathologic parameters, including number of pathologic nodes and extent of lymphadenectomy were correlated to disease recurrence. STUDY DESIGN: Retrospective chart review. RESULTS: The incidence of pathologic nodes in lymphadenectomy specimens (57.9%) and the recurrence rate (33.7%) were high, in our study population. In comparing techniques with address lymphadenopathy, the highest recurrence rate was observed in patients with pathologic nodes treated with "lymph node plucking" procedures at the time of thyroidectomy and those patients with multiple nodes involved. Few patients with no pathologic nodes, regardless of lymphadenectomy extent recurred. CONCLUSIONS: Our data show that limited neck dissection and disease burden are associated with the highest rates of cervical recurrence in regional metastatic PTC. Comprehensive functional neck dissection would seem to offer the patient the best opportunity for control of cervical metastasis. The American Thyroid Association recommends thyroglobulin monitoring and ultrasound evaluation of the neck in all postoperative patients. Therefore patients with the diagnosis of papillary thyroid cancer need preoperative ultrasound of the lateral neck and fine needle aspiration of suspicious nodes to avoid under-treating patients scheduled for total thyroidectomy. Neck dissection of the compartments in which pathologic nodes were detected (central, lateral, or both) should then be undertaken at the time of initial thyroidectomy. Eliminating all disease remains elusive and the prognostic significance of cervical disease persistence and recurrence is still unknown. Patients with cervical metastasis are at substantial risk of regional recurrence, necessitating repeat surgery. Parathyroid implantation should be considered at the time of the initial surgery to reduce the risk of hypoparathyroidism should subsequent procedures be required. More information will be necessary to better understand the prognostic significance of these regional metastases. In the interim, many patients may be over-treated, whereas some remain at risk of death because of disease.
机译：目的/假设：要描述我们机构在处理甲状腺乳头状癌（PTC）的宫颈转移方面的经验，并根据研究期间采用各种手术方法处理淋巴结肿大的患者的病理结节和宫颈复发的情况，提出治疗策略。材料与方法：在1972年12月1日至2007年9月1日之间，在匹兹堡大学医学中心诊断为PTC的183例患者接受了淋巴结清扫术。病理参数，包括病理结节数量和淋巴结清扫范围与疾病复发相关。研究设计：回顾性图表审查。结果：在我们的研究人群中，淋巴结清扫术标本中病理性淋巴结的发生率（57.9％）和复发率（33.7％）很高。在比较淋巴结肿大的技术时，在进行甲状腺切除术时采用“淋巴结拔除”手术治疗的病理淋巴结患者和涉及多个淋巴结的患者观察到最高的复发率。很少有无病理性淋巴结清扫的患者，无论其复发程度如何。结论：我们的数据显示有限的颈部夹层和疾病负担与区域转移性PTC的宫颈复发率最高相关。全面的功能性颈部解剖似乎为患者提供了控制宫颈转移的最佳机会。美国甲状腺协会建议对所有术后患者进行甲状腺球蛋白监测和颈部超声检查。因此，诊断为乳头状甲状腺癌的患者需要术前对颈外侧进行超声检查，并对可疑淋巴结进行细针穿刺，以免对计划进行甲状腺全切术的患者进行治疗不足。在初次甲状腺切除术时，应对发现了病理性淋巴结的部位（中央，外侧或两者）进行颈部解剖。消除所有疾病仍然遥遥无期，宫颈疾病持续和复发的预后意义仍然未知。宫颈转移患者存在区域复发的巨大风险，因此必须重复手术。初次手术时应考虑甲状旁腺的植入，以减少甲状旁腺功能低下的风险，如果需要后续手术的话。为了更好地了解这些区域转移的预后意义，将需要更多的信息。在此期间，许多患者可能会接受过度治疗，而有些患者仍可能因疾病而死亡。

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