Research Progress of Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma

doi:10.3969/j.issn.1007-9572.2016.36.026

Abstract

Abstract: Cervical lymph node metastasis is the main transfer pathway of papillary thyroid carcinoma （PTC）,the transfer order is usually from the central zone to lateral area.The diagnosis is difficult because of its occult onset,and the surgical scheme has not yet unified.Here we reviewed general rules,risk factors,diagnosis,treatment and prognosis of cervical lymph node metastasis in PTC,in order to help clinic screen high-risk patients with cervical lymph node metastasis of PTC and determine the reasonable treatment options.

Key words: Thyroid neoplasms, Lymphatic metastasis, Neck dissection

摘要： 临床上颈部淋巴结转移是甲状腺乳头状癌（PTC）最主要的转移途径，转移顺序通常是由中央区转移至颈侧区，其发病隐匿，诊断较困难，手术方案的选择尚未统一，本文就PTC颈部淋巴结转移的一般规律、高危因素、诊断、治疗及预后等情况作一个综述，期望为临床筛选PTC颈部淋巴结转移高危患者、确定合理的治疗方案提供帮助。

关键词: 甲状腺肿瘤, 淋巴转移, 颈淋巴结清扫术

HOU Wen-qun, YANG Xiao-min. Research Progress of Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma[J]. Chinese General Practice, 2016, 19(36): 4533-4536.

侯文群, 杨小敏. 甲状腺乳头状癌颈部淋巴结转移的研究进展[J]. 中国全科医学, 2016, 19(36): 4533-4536.

References

［1］SHAH J P，PATEL S G.头颈外科学与肿瘤学［M］. 韩德民,于振坤，译.3版.北京：北京人民卫生出版社,2005：5,355. SHAH J P，PATEL S G. Head and neck surgery and oncology［M］.HAN D M，YU Z K，translate. Beijing：Beijing People's Medical Publishing House,2005：5,355. ［2］ZETOUNE T,KEUTGEN X,BUITRAGO D,et al.Prophylactic central neck dissection and local recurrence in papillary thyroid cancer:a meta-analysis［J］.Ann Surg Oncol,2010,17（12）:3287-3293. ［3］LANG B H,NG S H,LAU L,et al.A systematic review and meta-analysis of prophylactic central neck dissection on short-term locoregional recurrence in papillary thyroid carcinoma after total thyroidectomy［J］.Thyroid，2013,23（9）:1087-1098. ［4］STOPA M,BARCZYNSKI M,KONTUREK A,et al.Prevalence of metastatic lymph nodes in the central compartment of the neck following prophylactic clearance for papillary thyroid cancer［J］.Przegl Lek,2011,68（12）:1166-1169. ［5］BIAN X,CHEN H,YE X,et al.Role of level VI lymph nodes metastasis in cervical metastasis of patients with papillary thyroid cancer［J］.Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi，2010,45（8）:664-668. ［6］LAI V,YEN T W,ROSE B T,et al.The effect of thyroiditis on the yield of central compartment lymph nodes in patients with papillary thyroid cancer［J］.Ann Surg Oncol,2015,22（13）:4181-4186. ［7］CHENG S P,LIU C L,HSU Y C,et al.Expression and biologic significance of diponectin receptors in papillary thyroid carcinoma［J］.Cell Biochem Biophys,2013,65（2）:203-210. ［8］LEE Y S,LIM Y S,LEE J C,et al.Nodal status of central lymph nodes as a negative prognostic factor for papillary thyroid carcinoma［J］.J Surg Oncol,2013,107（7）:777-782. ［9］PARK C H,SONG C M,JI Y B,et al.Significance of the extracapsular spread of metastatic lymph nodes in papillary thyroid carcinoma［J］.Clin Exp Otorhinolaryngol,2015,8（3）:289-294. ［10］CHEN Q,RAGHAVAN P,MUKHERJEE S,et al.Accuracy of MRI for the diagnosis of metastatic cervical lymphadenopathy in patients with thyroid cancer［J］.Radiol Med,2015,120（10）:959-966. ［11］CAMPENNI A,VIOLI M A,RUGGERI R M,et al.Clinical usefulness of 99mTc-MIBI scintigraphy in the postsurgical evaluation of patients with differentiated thyroid ancer［J］.Nucl Med Commun,2010,31（4）:274-279. ［12］ERBIL Y,SARI S,AGCAOGLU O,et al.Radio-guided excision of metastatic lymph nodes in thyroid carcinoma:a safe technique for previously operated neck compartments［J］.World J Surg，2010,34（11）:2581-2588. ［13］GILES Y S,SARICI I S,TUNCA F,et al.The rate of operative success achieved with radioguided occult lesion localization and intraoperative ultrasonography in patients with recurrent papillary thyroid cancer［J］.Surgery,2014,156（5）:1116-1126. ［14］KACZKA K,FENDLER W,BOROWIEC M,et al.First one-step nucleic acid amplification testing in papillary thyroid cancer lymph nodes——a comparison with histopathology and real-time PCR［J］.Endokrynol Pol,2014,65（6）:422-430. ［15］LIU X,OUYANG D,LI H,et al.Papillary thyroid cancer:dual-energy spectral CT quantitative parameters for preoperative diagnosis of metastasis to the cervical lymph nodes［J］.Radiology,2015,275（1）:167-176. ［16］LIU Y,XU Y,LIU Y,et al.Detection of cervical metastatic lymph nodes in papillary thyroid carcinoma by Fourier transform infrared spectroscopy［J］.Br J Surg,2011,98（3）:380-384. ［17］LIU Y Q,GAO M J,XU Y Z,et al.Investigation on Fourier transform infrared spectrum of metastatic lymph node in thyroid cancer［J］.Guang Pu Xue Yu Guang Pu Fen Xi,2009,29（11）:2917-2921. ［18］SOHN Y M,KIM M J,KIM E K,et al.Diagnostic performance of thyroglobulin value in indeterminate range in fine needle aspiration washout fluid from lymph nodes of thyroid cancer［J］.Yonsei Med J,2012,53（1）:126-131. ［19］TUMINO S,BELFIORE A.Appearance of antithyroglobulin antibodies as the sole sign of metastatic lymph nodes in a patient operated on for papillary thyroid cancer:a case report［J］.Thyroid,2000,10（5）:431-433. ［20］ZHANG H S,WANG R J,FU Q F,et al.Diagnostic value of thyroglobulin measurement with fine-needle aspiration biopsy for lymph node metastases in patients with a history of differentiated thyroid cancer［J］.Asian Pac J Cancer Prev,2014,15（24）:10905-10909. ［21］MIKOSINSKI S,POMORSKI L,SZUKOWSKA L,et al.The diagnostic value of thyroglobulin concentration in fine-needle aspiration of the cervical lymph nodes in patients with differentiated thyroid cancer［J］.Endokrynol Pol,2006,57（4）:392-395. ［22］SCHERL S,MEHRA S,CLAIN J,et al.The effect of surgeon experience on the detection of metastatic lymph nodes in the central compartment and the pathologic features of clinically unapparent metastatic lymph nodes:what are we missing when we don’t perform a prophylactic dissection of central compartment lymph nodes in papillary thyroid cancer? ［J］.Thyroid,2014,24（8）:1282-1288. ［23］VANNUCCHI G,COVELLI D,PERRINO M,et al.Ultrasound-guided percutaneous ethanol injection in papillary thyroid cancer metastatic lymph-nodes［J］.Endocrine,2014,47（2）:648-651. ［24］STACK BC J R,FERRIS R L,GOLDENBERG D,et al.American Thyroid Association consensus review and statement regarding the anatomy,terminology,and rationale for lateral neck dissection in differentiated thyroid cancer［J］.Thyroid,2012,22（5）:501-508. ［25］American Thyroid Association （ATA） Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer,COOPER D S,DOHERTY G M,et al.Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer［J］.Thyroid,2009,19（11）:1167-1214. ［26］HARTL D M,LEBOULLEUX S,AL GHUZLAN A,et al.Optimization of staging of the neck with prophylactic central and lateral neck dissection for papillary thyroid carcinoma［J］.Ann Surg,2012,255（4）:777-783. ［27］PERROS P,BOELAERT K,COLLEY S,et al.Guidelines for the management of thyroid cancer［J］.Clin Endocrinol（Oxf）,2014,81（Suppl 1）:1-122. ［28］MOO T A,MCGILL J,ALLENDORF J,et al.Impact of prophylactic central neck lymph node dissection on early recurrence in papillary thyroid carcinoma［J］.2010,34（6）:1187-1191. ［29］CALO P G,MEDAS F,PISANO G,et al.Differentiated thyroid cancer:indications and extent of central neck dissection-our experience［J］.Int J Surg Oncol,2013:625193.DOI:10.1155/2013/625193.Epub 2013 Sep 26. ［30］HOLOSTENCO V,KHAFIF A.The upper limits of central neck dissection［J］.JAMA Otolaryngol Head Neck Surg,2014,140（8）:731-735. ［31］KAMEYAMA K,TAKAMI H.Lymph node micrometastases of thyroid cancer［J］.Nihon Geka Gakkai Zasshi,2013,114（1）:34-37. ［32］KIKUMORI T,IMAI T.Our surgical strategy for thyroid carcinoma［J］.Nihon Rinsho,2007,65（11）:2029-2034. ［33］MACDONALD K I,TAYLOR S M,CAVANAGH J,et al.Level VI node size as a predictor of malignancy in papillary thyroid cancer［J］.J Otolaryngol Head Neck Surg,2010,39（2）:136-141. ［34］ZUNIGA S,SANABRIA A.Prophylactic central neck dissection in stage N0 papillary thyroid carcinoma［J］.Arch Otolaryngol Head Neck Surg,2009,135（11）:1087-1091. ［35］PAPINI E,BIZZARRI G,BIANCHINI A,et al.Percutaneous ultrasound-guided laser ablation is effective for treating selected nodal metastases in papillary thyroid cancer［J］.J Clin Endocrinol Metab,2013,98（1）:E92-97. ［36］LEE J,SONG Y,SOH E Y.Prognostic significance of the number of metastatic lymph nodes to stratify the risk of recurrence［J］.World J Surg,2014,38（4）:858-862. ［37］PARK Y M,WANG S G,LEE J C,et al.Metastatic lymph node status in the central compartment of papillary thyroid carcinoma:a prognostic factor of locoregional recurrence［J］.Head Neck,2016,38 （Suppl 1）:E1172-1176. ［38］PARK Y M,WANG S G,SHIN D H,et al.Lymph node status of lateral neck compartment in patients with N1b papillary thyroid carcinoma［J］.Acta Otolaryngol,2016,136（3）:319-324. ［39］SCHNEIDER D F,CHEN H,SIPPEL R S.Impact of lymph node ratio on survival in papillary thyroid cancer［J］.Ann Surg Oncol,2013,20（6）:1906-1911. ［40］URKEN M L.Management of well-differentiated thyroid cancer in 2010:perspectives of a head and neck surgical oncologist［J］.Endocr Pract,2010,16（5）:903-912. ［41］URKEN M L,HASER G C,IKHTEROV I,et al.The impact of metastatic lymph nodes on risk stratification in differentiated thyroid cancer:have we reached a higher level of understanding? ［J］.Thyroid,2016,26（4）:481-488.

[1]	BAI Xin, WU Xinyu, ZHAO Zun, LIU Shuxin, LIU Simiao, XUE Yuhang, XU Junling, GAO Yongju. Efficacy Analysis of ¹³¹I Therapy in Serum Thyroglobulin Antibody Positive Differentiated Thyroid Carcinoma with Distant Metastasis [J]. Chinese General Practice, 2024, 27(15): 1833-1837.
[2]	Xiangliu OUYANG, Bei GAO, Yanbin WANG, Liyun LIU, Cheng GU, Lichun ZHENG. Ultrasonographic Analysis of Primary Thyroid Lymphoma [J]. Chinese General Practice, 2022, 25(15): 1869-1874.
[3]	SUN Lei，LI Mei. TSH Suppression Therapy May Affect Bone Health，How to Manage Differentiated Thyroid Cancer Scientifically？ [J]. Chinese General Practice, 2021, 24(8): 941-946.
[4]	MA Dan，YIN Xinbo，LIU Jiahui，FANG Qunyao，HE Qiu，XIONG Yu，GONG Fanghua. Different Medications for Preventing 131I-induced Salivary Gland Damage in Thyroid Cancer Patients：a Network Meta-analysis　 [J]. Chinese General Practice, 2021, 24(30): 3828-3836.
[5]	WEN Ya，LIU Jingjing，LIU Liping，YAN Xiaohui，LI Xiaoyu，XIN Yuwei，BI Yanjing. Differential Analysis of Ultrasonographic and Intraoperative Characteristics between Focal Subacute Granulomatous Thyroiditis and Papillary Thyroid Carcinoma　 [J]. Chinese General Practice, 2021, 24(12): 1512-1516.
[6]	XIE Xingwei，LIU Chunmei，LIU Shuxian，SHEN Hang，ZHANG Daolong，ZHONG Liping，KONG Lingwei. Postoperative Diagnosis and Treatment of One Case of Thyroid Cancer：a Biopsychosocial Perspective　 [J]. Chinese General Practice, 2020, 23(5): 623-628.
[7]	GAO Fengjuan，ZHAO Jie，HAN Chengcheng，LIU Juhong，HE Zhihong，WEN Xiuqin，XIE Yan，ZHANG Ming，YAO Jun，YE Jingming. General Practitioner Health Management of a Patient with Differentiated Thyroid Cancer: a Teaching Case Study　 [J]. Chinese General Practice, 2020, 23(32): 4141-4145.
[8]	HE Yu，YANG Xi，YAN Hong，WANG Shuaiqi. Value of Preablation Stimulated Thyroglobulin，Stimulated Thyroglobulin，and Thyroglobulin Reduction Index in Predicting Long-term Remission Status in Differentiated Thyroid Cancer Patients Treated with Thyroid Remnant Ablation with 131I　 [J]. Chinese General Practice, 2020, 23(30): 3798-3805.
[9]	FANG Chao，WU Tingting，ZHOU Yingying，XUE Jun，YANG Weiwei. Value of a Combination of Ultrasound Examinations in Preoperative Diagnosis of Neck Lymph Node Metastasis in Papillary Thyroid Cancer　 [J]. Chinese General Practice, 2019, 22(24): 3000-3004.
[10]	WANG Yan，ZHANG Jinsong，MIAO Gang，LI Miao，ZHOU Yan，ZHANG Lina. Clinical Features of Primary Hyperparathyroidism　 [J]. Chinese General Practice, 2018, 21(35): 4392-4396.
[11]	JI Xin-qiang，SUN Jun-yong，LIU Jing. Clinicopathological Characteristics of Thyroid Cancer Patients Receiving Surgical Treatment in Peking University Cancer Hospital between 1996 and 2015：a Retrospective Cohort Study [J]. Chinese General Practice, 2018, 21(27): 3360-3365.
[12]	LI Fei，LI She-yu. Global Burden of Thyroid Cancer [J]. Chinese General Practice, 2018, 21(26): 3155-3159.
[13]	LANG Ran，JIN Jian-jun，ZHANG Peng-hui，BIAN Jing. Safety and Efficacy of Paclitaxel in the Treatment of Anaplastic Thyroid Cancer　 [J]. Chinese General Practice, 2018, 21(24): 2932-2936.
[14]	HUANG Ying-rui, CHEN Jie, ZHOU Ling-ling, LIANG Yong. Expression and Significance of Smad4 Gene in Papillary Thyroid Cancer [J]. Chinese General Practice, 2016, 19(32): 3961-3965.