切换至 "中华医学电子期刊资源库"

中华普通外科学文献(电子版) ›› 2022, Vol. 16 ›› Issue (01) : 56 -60. doi: 10.3877/cma.j.issn.1674-0793.2022.01.013

综述

甲状腺微小乳头状癌中Delphain淋巴结与颈不同区域淋巴结转移的相关性研究进展
崔思倩1, 李磊1, 张慧强1, 张进1, 刘静1,()   
  1. 1. 030000 太原,山西医科大学第一医院甲状腺外科
  • 收稿日期:2021-11-18 出版日期:2022-02-01
  • 通信作者: 刘静
  • 基金资助:
    山西省医学重点科技项目计划-引导性科技专项(2020XM57); "四个一批"山西省医学科技创新团队建设项目(甲状腺癌临床诊治和基础研究创新团队)(2020TD16)

Advances in the correlation between Delphain lymph nodes and lymph node metastasis in different cervical regions in thyroid micropapillary carcinoma

Siqian Cui1, Lei Li1, Huiqiang Zhang1, Jin Zhang1, Jing Liu1,()   

  1. 1. Department of Thyroid Surgery, the First Hospital of Shanxi Medical University, Taiyuan 030000, China
  • Received:2021-11-18 Published:2022-02-01
  • Corresponding author: Jing Liu
引用本文:

崔思倩, 李磊, 张慧强, 张进, 刘静. 甲状腺微小乳头状癌中Delphain淋巴结与颈不同区域淋巴结转移的相关性研究进展[J]. 中华普通外科学文献(电子版), 2022, 16(01): 56-60.

Siqian Cui, Lei Li, Huiqiang Zhang, Jin Zhang, Jing Liu. Advances in the correlation between Delphain lymph nodes and lymph node metastasis in different cervical regions in thyroid micropapillary carcinoma[J]. Chinese Archives of General Surgery(Electronic Edition), 2022, 16(01): 56-60.

甲状腺微小乳头状癌(PTMC)是指直径≤1 cm的甲状腺乳头状癌(PTC),恶性程度较低、整体预后较好,这可能与PTMC的惰性有关。但其在疾病早期仍容易发生局部淋巴结转移,有术后复发的风险。PTC颈部淋巴结转移好发生于中央区,目前已研究证实作为中央区的亚区淋巴结,Delphain淋巴结(DLN)为PTC最常转移的局部淋巴结区域,也是PTMC预后不良的标志。原发性肿瘤>1 cm、甲状腺腺外侵犯和峡部受累、肿瘤多灶性、包膜侵犯、淋巴血管侵犯等被认为是DLN转移的高危因素。目前对于DLN转移在PTMC疾病进展中的相关性研究仍不充分,本文从DLN转移规律及危险因素、DLN转移对于PTMC患者手术范围的制定及预后的影响等方面进行综述。

Papillary thyroid microcarcinoma (PTMC), a ≤1 cm-diameter thyroid papilloma (PTC), is a relatively inert subtype of thyroid cancer with low malignancy and relatively good overall prognosis. Local lymph node metastasis, on the other hand, is still susceptible to early stages of the disease, and there is a risk of recurrence after surgery. Thyroid papilloma cancer neck lymph node metastasis occurs in the central region, whereas the pre-throat lymph nodes, also known as Delphain lymph nodes (DLN), as the central region of the sub-region lymph nodes, has been confirmed as the most commonly transferred local lymph node region of PTC, and also a sign of PTMC's poor prognosis. Thyroid aggression and isthmus strain, tumor polysacousticity, capsule aggression, lymphatic vascular aggression, and other factors are thought to be high risk factors for DLN metastasis. There is currently relatively little association between DLN metastasis and the course of PTMC disease, thus this study analyzes the law of DLN metastasis and risk factors, the relevance of DLN metastasis for PTMC patients' operation scope and prognosis, and so on.

图1 中央区各亚区淋巴结解剖位置示意图 显示与甲状腺癌中央颈清扫相关的淋巴结位置
[1]
Feng JW, Ye J, Wu WX, et al. Management of cN0 papillary thyroid microcarcinoma patients according to risk-scoring model for central lymph node metastasis and predictors of recurrence[J]. J Endocrinol Invest, 2020, 43(12): 1807-1817.
[2]
Yin Y, Xu X, Shen L, et al. Influencing factors and cumulative risk analysis of cervical lymph node metastasis of papillary thyroid microcarcinoma[J]. Front Oncol, 2021, 11: 644-645.
[3]
Alabousi M, Alabousi A, Adham S, et al. Diagnostic test accuracy of ultrasonography vs computed tomography for papillary thyroid cancer cervical lymph node metastasis: A systematic review and Meta-analysis[J]. JAMA Otolaryngol Head Neck Surg, 2021, 12(24): 213-387.
[4]
Zhou SC, Liu TT, Zhou J, et al. An ultrasound radiomics nomogram for preoperative prediction of central neck lymph node metastasis in papillary thyroid carcinoma[J]. Front Oncol, 2020, 10: 1591.
[5]
Patel KN, Yip L, Lubitz CC, et al. The American Association of Endocrine Surgeons Guidelines for the definitive surgical management of thyroid disease in adults[J]. Ann Surg, 2020, 271(3): 21-93.
[6]
Gao M, Ge M, Ji Q, et al. 2016 Chinese expert consensus and guidelines for the diagnosis and treatment of papillary thyroid microcarcinoma[J]. Cancer Biol Med, 2017, 14(3): 203-211.
[7]
Dismukes J, Fazendin J, Obiarinze R, et al. Prophylactic central neck dissection in papillary thyroid carcinoma: all risks, no reward[J]. J Surg Res, 2021, 264: 230-235.
[8]
Chen L, Wu YH, Lee CH, et al. Prophylactic central neck dissection for papillary thyroid carcinoma with clinically uninvolved central neck lymph nodes: A systematic review and Meta-analysis[J]. World J Surg, 2018, 42(9): 2846-2857.
[9]
Ahn JH, Kwak JH, Yoon SG, et al. A prospective randomized controlled trial to assess the efficacy and safety of prophylactic central compartment lymph node dissection in papillary thyroid carcinoma[J]. Surgery, 2022, 171(1): 182-189.
[10]
Su H, Li Y. Prophylactic central neck dissection and local recurrence in papillary thyroid microcarcinoma: A meta-analysis[J]. Braz J Otorhinolaryngol, 2019, 85(2): 237-243.
[11]
安祥,余丹,李兵. 预防性中央区淋巴结清扫对甲状腺微小乳头状癌患者预后影响的Meta分析[J]. 临床耳鼻咽喉头颈外科杂志, 2019, 33(2): 138-142.
[12]
Medas F, Canu GL, Cappellacci F, et al. Predictive factors of lymph node metastasis in patients with papillary microcarcinoma of the thyroid: retrospective analysis on 293 cases[J]. Front Endocrinol (Lausanne), 2020, 11: 551.
[13]
Huang J, Sun W, Zhang H, et al. Use of Delphian lymph node metastasis to predict central and lateral involvement in papillary thyroid carcinoma: A systematic review and meta-analysis[J]. Clin Endocrinol (Oxf), 2019, 91(1): 170-178.
[14]
Li X, Duan Y, Liu D, et al. Diagnostic model incorporating clinicopathological characteristics of Delphian lymph node metastasis risk profiles in papillary thyroid cancer[J]. Front Endocrinol (Lausanne), 2021, 12: 591015.
[15]
闫云飞,刘娜,叶贝贝, 等. 喉前淋巴结与甲状腺乳头状癌颈部淋巴结转移的相关性研究[J]. 天津医科大学学报, 2021, 27(4): 369-373.
[16]
Isaacs JD, Lundgren C, Sidhu SB, et al. The Delphian lymph node in thyroid cancer[J]. Ann Surg, 2008, 247(3): 477.
[17]
Iyer NG, Kumar A, Nixon IJ, et al. Incidence and significance of Delphian node metastasis in papillary thyroid cancer[J]. Ann Surg, 2011, 253(5): 988-991.
[18]
American Thyroid Association Surgery Working Group, American Association of Endocrine Surgeons, American Academy of Otolaryngology-Head and Neck Surgery, et al. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer[J]. Thyroid, 2009, 19(11): 1153-1158.
[19]
Kim Y, Roh JL, Song DE, et al. Risk factors for posttreatment recurrence in patients with intermediate-risk papillary thyroid carcinoma[J]. Am J Surg, 2020, 220(3): 642-647.
[20]
Isaacs JD, McMullen TP, Sidhu SB, et al. Predictive value of the Delphian and level Ⅵ nodes in papillary thyroid cancer[J]. ANZ J Surg, 2010, 80(11): 834-838.
[21]
Wang B, Wen XZ, Zhang W, et al. Clinical implications of Delphian lymph node metastasis in papillary thyroid carcinoma: A single-institution study, systemic review and meta-analysis[J]. J Otolaryngol Head Neck Surg, 2019, 48(1): 42.
[22]
Kim DH, Kim SW, Hwang SH. Predictive value of Delphian lymph node metastasis in the thyroid cancer[J]. Laryngoscope, 2021, 131(9): 1990-1996.
[23]
Zheng G, Zhang H, Hao S, et al. Patterns and clinical significance of cervical lymph node metastasis in papillary thyroid cancer patients with Delphian lymph node metastasis[J]. Oncotarget, 2017, 8(34): 57089-57098.
[24]
Lan X, Sun W, Zhang H, et al. A Meta-analysis of central lymph node metastasis for predicting lateral involvement in papillary thyroid carcinoma[J]. Otolaryngol Head Neck Surg, 2015, 153: 731-738.
[25]
Tan Z, Ge MH, Zheng CM, et al. The significance of Delphian lymph node in papillary thyroid cancer[J]. Asia Pac J Clin Oncol, 2017, 13: 389-393.
[26]
So YK, Kim MJ, Kim S, et al. Lateral lymph node metastasis in papillary thyroid carcinoma: A systematic review and meta-analysis for prevalence, risk factors, and location[J]. Int J Surg, 2018, 50: 94-103.
[27]
Shaha AR, Migliacci JC, Nixon IJ, et al. Stage migration with the new American Joint Committee on Cancer (AJCC) staging system (8th edition) for differentiated thyroid cancer[J]. Surgery, 2019, 165(1): 6-11.
[28]
Zhu Y, Lin J, Yan Y, et al. Delphian lymph node metastasis is a novel indicator of tumor aggressiveness and poor prognosis in papillary thyroid cancer[J]. J Surg Oncol, 2021, 123(7): 1521-1528.
[1] 陈启阳, 刘玉江, 刘金苹, 谭小蕖, 钱林学, 胡向东. 基于超声造影的预测模型对甲状腺乳头状癌颈中央区淋巴结转移的诊断价值[J]. 中华医学超声杂志(电子版), 2023, 20(04): 442-448.
[2] 刘黎平, 刘皓希, 何鑫, 杨新华. 年轻巨大乳腺浸润性乳头状癌一例[J]. 中华乳腺病杂志(电子版), 2022, 16(03): 190-192.
[3] 张娜, 易茂林. 微波消融术与甲状腺腺叶切除术对BRAFV600E基因野生型cN0甲状腺微小乳头状癌临床效果对比研究[J]. 中华普通外科学文献(电子版), 2022, 16(01): 9-13.
[4] 聂阿娜, 尚培中, 苗建军, 王金, 李伟. 甲状腺乳头状癌SLeX和Gal-3表达的临床病理意义[J]. 中华普通外科学文献(电子版), 2021, 15(06): 432-436.
[5] 赵敬柱, 郑向前, 高明, 赵金坤, 魏松锋, 运新伟, 池嘉栋. 甲状腺乳头状癌上纵隔淋巴结转移的诊治思考:附2例报告及文献复习[J]. 中华普通外科学文献(电子版), 2021, 15(04): 293-297.
[6] 崔占斌, 乔军利, 张丽丽, 韩明强. 尿碘水平与甲状腺乳头状癌患者术后复发危险度分层的相关性[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 615-618.
[7] 袁育韬, 邢金琳, 谢克飞, 殷凯. CT征象及BRAFV600E基因突变与甲状腺乳头状癌中央区淋巴结转移的相关性[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 611-614.
[8] 樊丽超, 郭瑾瑛, 陈鑫. 野生型RET与RET/PTC融合基因检测对甲状腺乳头状癌中央区淋巴结清扫的指导意义[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 631-635.
[9] 李建东, 李卓良, 殷涛. 甲状腺乳头状癌颈内静脉后群淋巴结转移的临床研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(02): 184-187.
[10] 陈伟, 邱钧, 李志贵, 朱锋, 唐国华, 李添亮. 胸锁乳突肌肌间入路对桥本病合并甲状腺乳头状癌临床运用分析[J]. 中华普外科手术学杂志(电子版), 2022, 16(04): 447-450.
[11] 文骝, 庞士勇, 李娟. 两种手术方式治疗甲状腺微小乳头状癌的安全性及近期预后比较[J]. 中华普外科手术学杂志(电子版), 2021, 15(04): 447-449.
[12] 李俊强, 邱春丽, 李宏, 宫小勇, 周智辉, 李媛媛, 代引海. 改良Miccoli术式与完全腔镜术式治疗甲状腺微小乳头状癌的临床效果对比研究[J]. 中华普外科手术学杂志(电子版), 2021, 15(03): 331-334.
[13] 吴元清, 林杰, 罗佳宝, 邱堃, 黄平. 甲状腺微小乳头状癌淋巴结转移和腺外侵犯的危险因素分析[J]. 中华普外科手术学杂志(电子版), 2021, 15(03): 319-322.
[14] 许思哲, 贺功建, 曾黎, 杨蕙嘉, 王芳. 超声联合肿瘤标记物对cN0期甲状腺微小乳头状癌中央区淋巴结隐匿性转移的预测价值[J]. 中华普外科手术学杂志(电子版), 2021, 15(03): 314-318.
[15] 王猛, 郑鲁明, 李小磊, 周鹏, 王刚, 朱见, 厉彦辰, 贺青卿. 经口腔前庭机器人甲状腺癌择区性颈淋巴结清扫的初步探讨[J]. 中华腔镜外科杂志(电子版), 2022, 15(06): 347-351.
阅读次数
全文


摘要