Value of jugulo-omohyoid lymph nodes in predicting lateral cervical occult metastasis in patients with papillary thyroid carcinoma
Author(s): An Changming, Wang Yan, Wang Shixu, Yin Yulin, Chen Moqi, Xu Zhengang, Tang Pingzhang, Li Zhengjiang
Pages: 207-210
Year: 2017 Issue: 3
Journal: Chinese Journal of Oncology
Keyword: Thyroid neoplasms; Jugulo-omohyoid lymph nodes; Neoplasm metastasis; Lymph nodes; Super-selectiveneck dissection;
Abstract: Objective To investigate the value of jugulo-omohyoid lymph nodes ( JOHLN ) in predicting occult lateral cervical lymph node metastasis in patients with papillary thyroid carcinoma ( PTC) . Methods The clinicopathological data of 136 out of 2100 PTC patients, who had a high risk of lateral neck lymph node metastasis and treated by us from January 2010 to December 2015, were retrospectively analyzed. Super selective neck dissection ( SSND, level Ⅲ and Ⅳ) was performed and JOHLNs were sent for frozen section in all the 136 cases. The clinicopathological data was analyzed and the significance of JOHLN in predicting lateral cervical LNM was calculated using the SPSS software package. Results Of the 136 patients, total thyroidectomy was performed in 76 cases (55.9%) and unilateral lobectomy plus isthmus was performed in the other 60 cases ( 44. 1%) . SSND was performed in 72 patients ( 52. 9%) , level Ⅱ-Ⅳ dissection in 15 (11.0%), and level Ⅱ-Ⅴ dissection in 49 (36.0%). According to the pathological results, 38 patients were pN0( 27. 9%) , 18 ( 13. 2%) were pN1a and 80 ( 58. 8%) were pN1b. The lymph node metastasis( LNM) rates at level Ⅱ-Ⅵ were 19.9%, 43.4%, 42.6%, 2.9%, and 59.6%, respectively. The sensitivity, specificity and accuracy of JOHLN in predicting lateral neck metastasis were 58. 8%, 62. 9%,and 76.7%, respectively. The rates for predicting level Ⅱ metastasis were 81. 5%, 43. 2%, and 59. 4%, respectively. None of the patients died in the follow-up. Only 1 recurrence was found in level Ⅱ and regional control was achieved after level Ⅱ and Ⅴ dissection. Conclusions JOHLN has a high accuracy for predicting lateral cervical lymph node metastasis and high sensitivity for level Ⅱ metastasis. For patients with high risk of lateral cervival metastasis, super-selective neck dissection including level Ⅲ and Ⅳ can confirm the stage and reduce the risk of reoperation. Dissection for level Ⅱ,Ⅲ, and Ⅳ is recommended.
Pages: 207-210
Year: 2017 Issue: 3
Journal: Chinese Journal of Oncology
Keyword: Thyroid neoplasms; Jugulo-omohyoid lymph nodes; Neoplasm metastasis; Lymph nodes; Super-selectiveneck dissection;
Abstract: Objective To investigate the value of jugulo-omohyoid lymph nodes ( JOHLN ) in predicting occult lateral cervical lymph node metastasis in patients with papillary thyroid carcinoma ( PTC) . Methods The clinicopathological data of 136 out of 2100 PTC patients, who had a high risk of lateral neck lymph node metastasis and treated by us from January 2010 to December 2015, were retrospectively analyzed. Super selective neck dissection ( SSND, level Ⅲ and Ⅳ) was performed and JOHLNs were sent for frozen section in all the 136 cases. The clinicopathological data was analyzed and the significance of JOHLN in predicting lateral cervical LNM was calculated using the SPSS software package. Results Of the 136 patients, total thyroidectomy was performed in 76 cases (55.9%) and unilateral lobectomy plus isthmus was performed in the other 60 cases ( 44. 1%) . SSND was performed in 72 patients ( 52. 9%) , level Ⅱ-Ⅳ dissection in 15 (11.0%), and level Ⅱ-Ⅴ dissection in 49 (36.0%). According to the pathological results, 38 patients were pN0( 27. 9%) , 18 ( 13. 2%) were pN1a and 80 ( 58. 8%) were pN1b. The lymph node metastasis( LNM) rates at level Ⅱ-Ⅵ were 19.9%, 43.4%, 42.6%, 2.9%, and 59.6%, respectively. The sensitivity, specificity and accuracy of JOHLN in predicting lateral neck metastasis were 58. 8%, 62. 9%,and 76.7%, respectively. The rates for predicting level Ⅱ metastasis were 81. 5%, 43. 2%, and 59. 4%, respectively. None of the patients died in the follow-up. Only 1 recurrence was found in level Ⅱ and regional control was achieved after level Ⅱ and Ⅴ dissection. Conclusions JOHLN has a high accuracy for predicting lateral cervical lymph node metastasis and high sensitivity for level Ⅱ metastasis. For patients with high risk of lateral cervival metastasis, super-selective neck dissection including level Ⅲ and Ⅳ can confirm the stage and reduce the risk of reoperation. Dissection for level Ⅱ,Ⅲ, and Ⅳ is recommended.
Related Articles