The Study Of Ultrasonography Diagnosis And Metastatic Trend Of Metastatic Cervical Lymph Nodes Of Differentiated Thyroid Carcinoma

Objective:To discuss the application value of Methylene blue,Carbonnanoparticles as two biological dyes in tracing of the sentinel lymph node(SLN) of differentiated thyroid cancer.To analyze the relationship and transfertrend between primary focal position and metastatic cervical lymph nodes ofdifferentiated thyroid carcinoma,and to evaluate the diagnostic significance ofpreoperative ultrasonography in the diagnosis of metastatic lymph nodes ofdifferentiated thyroid cancer.Methods:To select81differentiated thyroid carcinoma patients who werehighly doubted by the clinical preoperative ultrasonography and werediagnosed by intraoperative rapid frozen pathological examination.81cases ofpatients were all chosen to undergo neck ultrasonography. The thyroid glandwere exposed to find and confirm the primary tumor position in the operation.40patients who were selected randomly among them were given1%methylthioninium chloride injection0.3-0.5ml along the primary tumor by3-4points before operation, after10-15mins exactly to find the aizen lymphaticpipeline, and to trace the aizen lymph nodes.The other41patients were given1%carbon nanoparticles suspension injection0.3-0.4ml along the primarytumor by3-4points before operation, after15-30mins exactly to find the blackdye lymphatic pipeline, and to trace the black dye lymph nodes. Meanwhilepaying attention to protect undyed parathyroid tissue.Then to devote the tissueof primary tumor and dyeing sentinel lymph nodes to examination ofintraoperative rapid freezing pathology inspection.We should combined withthe operation and frozen pathological result to decide the operation mode. Topartition and count the sentinel lymph nodes and neck specimens lymphnodes.All the data was analyzed with statistics. Results:181patients, a total of88neck dissection specimens,94centralcompartment dissection specimens. The result of postoperative pathologyconfirmed that the sensitivity, specificity of the positive central area andlateral neck nodes by preoperative ultrasonography respectively was54%,64.5%and83.1%,86.2%.240cases of methylene blue group,41cases of carbon nanoparticles group,The detection rate, accuracy rate of the two kinds of tracer were87.5%,91.4%, and92.7%,94.7%separately, the difference has no statisticalsignificance (P>0.05). The difference of two groups patients withpostoperative transient hypocalcemia incidence—methylene blue groupwas47.4%(9/19), nano carbon group was5.6%(1/18)—which wasstatistically significant (χ2=8.194,P<0.05).3Among the81patients,73cases were detected the SLN which contained213pieces of lymph nodes. The distribution of them in level II, III, IV, Vand the central area were4.2%(9/213)、17.9%(38/213)、23.9%(51/213)、0.9%(2/213)、53.1%(113/213) respectively. The distribution of SLNs inneck central area was significantly higher than other districts (P<0.05), thedifference has statistical significance. Among them Primary tumor locatedin lower pole and at the isthmus that most found SLNs in the centralarea,which was higher than that of the other region of neck, the differencewas statistically significant (P<0.05). While the primary tumor located onthe upper pole,middle and the whole gland leaf, which the distribution ofSLN had no significant differences between the center and the side of theneck (P>0.05).4The number of metastatic SLNs were a total of107pieces in81patients,the metastatic SLNs were most in neck centralarea(61/107,57.0%),next in level IV (24/107,22.4%)、Ⅲ (17/107,15.9%)、Ⅱ(5/107,4.7%)、 Ⅴ0piece. For this study,in SLN metastasis cases, theprimary tumor position which were located on the upper pole had10cases, contained27pieces.The distribution was in level II(3/27,11.1%)、 III(9/27,33.3%)、IV(5/27,18.5%) and neck central area(10/27,37.1%),themost in neck central area,nothing in level V. The primary tumor positionwhich were located on the middle had6cases, contained13pieces.Andthey were only distributed in level IV (38.5%,5/13)and central area(61.5%,8/13). The primary tumor position wihch were located on thelower pole had7cases, contained18pieces,which were mainlydistributed in neck central area(83.3%,15/18). The primary tumorposition which were located at the isthmus had4cases, contained9pieces,which were also most distributed in neck central area (77.8%,7/9).The primary tumor position which were occupied the whole gland had19cases, among them14cases were found metastatic SLNs in neck centralarea,the distribution was significantly higher than the other district, thedistribution of the difference was statistically significant (P<0.05).Contained40pieces,which were distributed in level II（5%,2/40）、III（15%，6/40）、IV (27.5%,11/40)and neck central area (52.5%,21/40).5The number of metastatic cervical lymph nodes were a total of316piecesin81patients，average3.90. Among them, the distribution of metastaticcervical lymph nodes were most in neck central area, a total of135pieces(135/316,42.7%).And meanwhile,for this study, the metastatic tendency ofcervical lymph nodes of differentiated thyroid cancer was that thedistribution of metastatic cervical lymph nodes were most in neck centralarea, about77.8%(63/81), followed by level III50.6%(41/81), IV46.9%(38/81), II24.7%(20/81), V11.1%(9/81), VII2.5%(2/81). Thedistribution in central area was significantly higher than the other district,the distribution of the difference was statistically significant (χ2=87.389,P<0.05); the distribution in level III, IV was significantly higher than thatin level II, V, VII, the difference of which was statisticallysignificant(P<0.05), level III, IV had no significant difference (χ2=0.222,P>0.05).Conclusions:1Preoperative ultrasonography has higher reference value analysis for differentiated thyroid carcinoma lymph nodes in the neck.2Methylene blue, carbon nanoparticles as two biological dye tracers wereused of tracing the differentiated thyroid cancer SLNs, which were safeand effective.There were no significant differences in the results of thedetection rate, accuracy rate, sensitivity, specificity and false negative rate.But carbon nanoparticles has the unique advantage of effective protectingthe parathyroid glands and reducing the occurrence of postoperative lowcalcium complications.3The sentinel lymph node biopsy of differentiated thyroid cancer bybiological dye, which is safe and feasible, has certain significance forjudging the metastasis of cervical lymph nodes.It is a kind of idealoperation methods to handle the metastatic cervical lymph nodes, whichhas the guiding significance to ensure the boundary of operation.4The primary tumor location of differentiated thyroid cancer also hascertain influence in the distribution of the SLNs. The location of SLNs canbe detected by combing with primary tumor position and stained situation.5The metastatic cervical lymph nodes of differentiated thyroid cancer hasthe highest metastatic in neck central area, followed by lateral neck levelIII,level IV,level II, and the level V transfered minimum.