| Objective:At present,there are some differences in the treatment of cervical lymph nodes of papillary thyroid cancer,especially in the central lymph node dissection.To explore the related factors of cervical lymph node metastasis of papillary thyroid carcinoma,provide a theoretical basis for predicting cervical lymph node metastasis,and help guide the clinical development of treatment plan and risk assessment of recurrence.Methods:The clinical and pathological data of 1271 patients with thyroid papillary carcinoma who underwent surgery from July 2010 to October 2016 in the Head and Neck Surgery Center of Sichuan Cancer Hospital were collected.The risk factors of lymph node metastasis in the central and lateral neck regions were retrospectively analyzed.Results:A total of1271 patients were enrolled in this study.The youngest was 7 years old,the largest was 86 years old,and the average age was 42.65±12.79 years old.Among them,331 males,the average age was 43.46±12.47 years old,and 940 females,the average age was 42.36.±12.89 years old.Among the patients,1254 patients underwent central lymphadenectomy(one or both sides)and obtained postoperative pathological findings.Among them,581 patients underwent lateral neck dissection,and the positive rates of lymph node metastasis in central and lateral cervical regions were54.7%,65.1%.Univariate analysis showed that the pathological features of the tumor were related to the lymph node metastasis rate in the central lymph node and lateral cervical region.The results showed that the capsule was invaded(positive rates were 65.3%,72.8%,?~2=29.551,11.564,P<0.001),and multiple lesions(The positive rates were 68.8%,70.3%,?~2=44.347,P<0.001,?~2=4.005,P=0.045),and multilobal involvement(positive rates were 70.5%,71.3%,?~2=40.536,P<0.001,?~2=4.464,P=0.035)and tumor location(the tumor is located in the lower third of the glandular lobe and the tumor is located in the upper third of the glandular lobes.The positive rate of lymph node metastasis in the central region and lateral cervical region is 66.9%and 80.6%,respectively,?2=26.441,34.661,P<0.001),tumor maximum diameter(?~2=78.188a,36.911,P<0.001,a:trend chi-square test)and other factors have an impact on central and lateral cervical lymph node metastasis;Central Lymph Node Metastasis(CLNM),the positive rate was 61.7%for males and 52.2%for females(?~2=8.813,P=0.003);different age composition ratios were mainly related to lateral cervical lymph node metastasis(Lateral Lymph)Related to Node Metastasis,LLNM),Age is divided into?55 years old and>55 years of age groups,the positive rates were 67.6%,54.1%(?~2=7.054,P=0.008).Multivariate logistic regression analysis showed that the extracapsular invasion(OR=1.909,P<0.05),tumor location,central metastasis(OR=8.978,P<0.05),and tumor maximum diameter(OR=1.817,P<0.05).As an independent risk factor for LLNM,the tumor was located in the lower third of the glandular lobes and had the most significant effect on CLNM(OR=4.035,P<0.05).Among 378 patients with positive cervical lymph node metastasis,49 patients had skipping lateral cervical lymph node metastasis.Univariate analysis indicated that the lymph node metastasis was mainly related to age(>55 years old,the positive rate was 22.8%,?~2=5.414,P=0.020),number of lesions(single focus,positive rate was17.4%,?~2=8.713,P=0.003),glandular involvement(unilateral glandular involvement,positive rate 15.9%,?~2=4.460,P=0.035),Tumor location(tumor located in the upper third of the gland,positive rate of 25.8%,?~2=21.957,P<0.001)and other risk factors.The differences between different tumor sizes were analyzed.The results showed that the maximum diameter of the tumor was>1 cm and the maximum diameter of the tumor was>2 cm,which was the node with increased lymph node metastasis rate in the central and lateral neck regions(the positive rates were 66.6%and 81.0%,respectively,?~2=79.873,38.454,P<0.001).Conclusion:Male,capsule invasion,multiple lesions,multi-leaf involvement,tumor located in the lower third of the glandular lobe,tumor maximum diameter>1cm is a risk factor for CLNM,and LLNM is mainly associated with age(?55 years),the capsule is affected.Invasive,multiple and multi-lobed lesions,tumors located in the upper third of the glandular lobes,the largest diameter of the tumor>2cm and other clinical pathological features.Age>55 years,single leaf and single lesion,tumor located in the upper third of the glandular lobe is a risk factor for skip metastasis.Objective:Advanced PTC often involves adjacent important tissue structures.It is very difficult for preoperative surgeons to accurately evaluate the clinicopathological features and lymph node metastasis of the tumor based on two-dimensional imaging data.To evaluate the clinicopathological features of advanced thyroid papillary carcinoma by three-dimensional visualization technique,and to explore the application value of three-dimensional visualization technique in the surgical treatment of advanced thyroid cancer.Methods: A patient with advanced papillary thyroid carcinoma was enrolled.The enhanced CT data was collected and input into the 3D visualization system for stereo imaging.Results: Three-dimensional visualization technology was used to successfully construct a three-dimensional visualization model of patients.It not only showed multiple lesions of PTC,tumor size and tumor location,but also showed three-dimensional spatial relationship between PTC primary tumor and cervical metastatic lymph nodes and adjacent important structures from multiple angles.In particular,it is related to important blood vessels and nerves in the neck.Conclusion: Three-dimensional visualization technology can clearly display the anatomical relationship between tumor and head and neck important tissues and structures,and evaluate the number,size and location of tumors before operation.Preoperative evaluation of tumors,metastatic lymph nodes and surgical feasibility are guided by preoperative model guidance.To ensure the safety of thyroidectomy and cervical lymph node dissection,it has great application prospects in the future advanced thyroid papillary carcinoma,especially in patients with adjacent tissue involvement and extensive cervical lymph node metastasis.Evaluation of PTC clinical pathology features provides new options. |
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