Clinical Study On The Lymph Node Metastasis Rule And The Feasibility Of Sentinel Lymph Node Biopsy In The Sisth Region In Papilary Thyroid Microcarcinoma

[Background]:Thyroid carcinoma is prevalent and with higher incidence in endocrine system,secondly to the ovarian carcinoma.In recent years,the incidence of thyroid carcinoma was gradually increasing in a higher speed.With the application of the health examination,high-resolution ultrasonography and other auxiliary diagnosis equipments,the detection rate of papillary thyroid carcinoma,especially papillary thyroid microcarcinoma(T≤10mm) has been increased significantly.With the rapid development of the sentinel lymph node in thyroid surgery,the surgical approach needs to be further optimized.[Objective]:To study the nano-carbon lymphatic tracing in papillary thyroid microcarcinoma(PTMC) of the Ⅵ region lymph nodes and sentinel lymph nodes(SLN) distribution,and the feasibility of sentinel lymph node biopsy(SLNB).[Methods]:39 cases of patients from The Department of Throid Surgery of Qianfoshan Hospital Affiliated to Shandong University was selected and their database was analyzed during the time between 2012-12 and 2013-12.Nano-carbon lymphatic tracer techniques were applied to find and help to cut Ⅵ region stained lymph nodes besides other accessory lymphatic and adipose tissue,none dissected altogether routinely.Meanwhile,the laryngeal recurrent nerve and parathyroid gland were protected.The number of the stained and the unstained lymph node wae calculated respectively according to the pathological result with analysis of metastasis rule.[Results]:Sentinel lymph nodes in the VI region were detected in 34 out of the 39 cases of the patients with PTMC,the detection rate was 87.2%.SLN were positive in the 16 cases wiyh the positive rate 47.1%(16/34),while negative cases was 18,negative rate 52.9%(18/34).Two cases were False-negative(SLN-negative but other lymph nodes were positive) with false-negative rate 5.1%(2/39).The positive predictive accuracy of SLN to the VI region lymph node metastasis was 100% (16/16), the sensitivity was 87.2%(34/39), all the accuracy was 94.1%(32/34).Also we found that the lymphatic vessels and lymph nodes around the thyroid were black dyed with parathyroid unstained.In this situation,parathyroid could be easyly protected orthotopically.No permanent damage of parathyroid was seen postoperatively.[Conclusion]:① The Ⅵ region is the important region of lymph node metastasis in PTMC. ② SLNB can accurately predict lymph node metastasis in the VI region of PTMC patients and it study provides a theoretical basis for the clinical application which in the VI region lymph node dissection can be replaced by SLNB. ③ The parathyroid glands can be effectively protected orthotopically by the nano-carbon traceing for the VI region lymph nodes.