| Objectives:Objective to evaluate the accuracy of ultrasound in guiding elective lateral cervical lymph node dissection and analyze the clinical significance of elective lateral cervical lymph node dissection and the risk factors affecting lateral cervical lymph node metastasis.Methods:In this study,196 patients with papillary thyroid carcinoma((PTC))who underwent lateral cervical lymph node dissection(Ⅱ,Ⅲ,Ⅳ,Ⅴ B)in our department from October 2018 to January 2021 were analyzed retrospectively.all the patients were confirmed to be thyroid papillary carcinoma.The patients were divided into two groups according to whether the ultrasonic signs of lateral cervical lymph nodes were in line with the criteria in the Code for diagnosis and treatment of thyroid Cancer(2018Edition).Lateral neck dissection was performed on all patients with papillary thyroid carcinoma with abnormal ultrasonographic findings of lateral cervical lymph nodes.All the resected tissues were sent to pathology after operation.By comparing the consistency of preoperative cervical ultrasound and postoperative pathological results,the accuracy of ultrasound in guiding lateral cervical lymph node dissection was judged and the clinical significance of elective lateral cervical lymph node dissection was analyzed.The gender,age,diameter of primary focus,number of primary focus,location of primary focus,extraglandular invasion,central lymph node metastasis and lateral cervical lymph node metastasis of patients included in this study were statistically analyzed.χ 2 test and Logistic regression model were used to analyze the relationship between the above factors and lateral neck metastasis.Results:In this study,a total of 235 sides of lateral cervical lymph nodes were dissected in this study.postoperative pathology confirmed that lateral cervical lymph nodes were positive in 205 sides(87.2%)and negative in 30 sides(12.8%).That is the positive predictive value of ultrasound in the diagnosis of cervical lymph node metastasis in PTC was87.23%.By analyzing the related factors of abnormal cervical lymph nodes revealed by ultrasound,it was concluded that tumor location(upper thyroid 1/3),central lymph node metastasis and other benign thyroid diseases were independent risk factors of lateral cervical lymph node metastasis.The ultrasonographic features of lateral cervical lymph nodes are in accordance with the Chinese Code for diagnosis and treatment of thyroid Cancer(2018 Edition).In patients undergoing therapeutic lateral neck dissection,the location of the tumor(upper thyroid 1/3)and extraglandular invasion are independent risk factors.In addition,in patients with abnormal lateral cervical lymph nodes who underwent selective lateral neck dissection,tumor location(upper thyroid 1/3),tumor diameter(>1cm)and other benign thyroid diseases were also independent risk factors for lateral cervical metastasis.There was no significant correlation between gender and age and the occurrence of lateral cervical metastasis.Conclusions:1.Ultrasonography is an important method for preoperative examination of thyroid diseases,which is economical and non-invasive,with high accuracy,and can be widely used in clinic.Through the preoperative evaluation of ultrasound and other auxiliary examination results,combined with the risk factors of lateral cervical metastasis,a more accurate operation plan was made to guide the postoperative treatment and follow-up plan.2.In addition to therapeutic cervical lymph node dissection for PTC patients with preoperative ultrasonographic evaluation and pathologically confirmed lateral cervical lymph node metastasis(c N1b),PTC patients with abnormal cervical lymph nodes revealed by ultrasound but failed to meet the ultrasonographic signs in the criteria for diagnosis and treatment,especially those whose primary focus was located in the superior thyroid gland,the diameter of the primary focus > 1cm,or complicated with other benign thyroid diseases.Selective lateral cervical lymph node dissection should be performed actively.3.The independent risk factors of cervical lymph node metastasis in patients with PTC are primary tumor located in the upper part of thyroid gland,central lymph node metastasis and other benign thyroid diseases.For such patients,if abnormal signs of cervical lymph nodes are revealed by ultrasonography,cervical lymph node dissection should be performed actively.PTC patients with tumor diameter > 1.0cm and primary tumor with multiple tumors had a higher risk of cervical lymph node metastasis. |
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