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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 .. >Patterns and Predictors of Metastatic Spread to the Neck in Pediatric Thyroid Carcinoma
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Patterns and Predictors of Metastatic Spread to the Neck in Pediatric Thyroid Carcinoma

机译：转移性蔓延到小儿甲状腺癌颈部的模式和预测因子

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Objective Evaluate patterns and predictors of spread to the neck in pediatric metastatic differentiated thyroid carcinoma (DTC). Methods Patients <18 years old undergoing thyroidectomy by a single surgeon from January 2015 to December 2019 were included. Neck sublevels were removed separately according to AJCC boundaries. Clinical outcomes included nerve injury, hypocalcemia, hematoma, and residual tumor. Results Forty-eight children underwent thyroid surgery. Thirty (63%) were for malignancy, 27 (90%) of which were DTC. Nineteen (70%) patients with DTC underwent 24 neck dissections; 19 central plus lateral and 5 central alone. The female to male ratio increased from 1:1 to 3:1 with age. Two children with lateral neck involvement had sub-centimeter primaries. Patients requiring neck dissection were more likely to have 1) diffuse sclerosing or tall cell variant, 2) T3 or T4 disease, 3) genetic mutation, 4) lymphatic invasion, 5) extracapsular extension, 6) positive resection margin. Levels IIA (79%), III (89%), IV (84%), VI (100%) were most commonly involved. Levels IB (16%), IIB (16%), VB (16%) were also involved, often without involvement of adjacent levels. Permanent injuries included one unilateral recurrent laryngeal nerve, one mild marginal mandibular nerve and one mild accessory nerve. Hypocalcemia was highest following neck dissection for malignant disease. One patient was re-operated for a mediastinal node. Most patients with N1 disease received radioactive iodine. Most patients have no evidence or indeterminate disease on long-term follow-up. Conclusion Children with lateral nodal spread from DTC should be considered for neck dissection including Levels IB, IIA, IIB, III, IV, VB, bilateral VI. Level of Evidence 4Laryngoscope, 2020
机译：目的评估儿童转移性分化型甲状腺癌（DTC）颈部扩散的模式和预测因素。方法纳入2015年1月至2019年12月由一名外科医生进行甲状腺切除术的18岁以下患者。根据AJCC边界分别移除颈部亚层。临床结果包括神经损伤、低钙血症、血肿和残余肿瘤。结果48例儿童接受了甲状腺手术。恶性肿瘤30例（63%），其中DTC 27例（90%）。19例（70%）DTC患者接受了24次颈部解剖；19个中央加外侧，5个中央。随着年龄的增长，男女比例从1:1增加到3:1。两名侧颈受累的儿童有亚厘米级初选。需要颈淋巴结清扫术的患者更有可能出现1）弥漫性硬化或高细胞变异，2）T3或T4疾病，3）基因突变，4）淋巴管侵犯，5）囊外扩张，6）切缘阳性。IIA水平（79%）、III水平（89%）、IV水平（84%）、VI水平（100%）最常见。IB级（16%）、IIB级（16%）、VB级（16%）也参与，通常不涉及相邻级别。永久性损伤包括一条单侧喉返神经、一条轻度下颌边缘神经和一条轻度副神经。恶性疾病颈清扫术后低钙血症最高。一名患者因纵隔淋巴结再次手术。大多数N1病患者接受放射性碘治疗。大多数患者在长期随访中没有证据或病情不明。结论对于因DTC而出现外侧淋巴结扩散的儿童，应考虑进行颈清扫，包括IB、IIA、IIB、III、IV、VB、双侧VI级。证据级别4喉镜，2020年

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