Papillary thyroid microcarcinoma(PTMC)measures 1 cm or less in its longest dimension.The incidence of PTMC is increasing worldwide.Surgery is the primary treatment;however,prophylactic central lymph node dissection is...Papillary thyroid microcarcinoma(PTMC)measures 1 cm or less in its longest dimension.The incidence of PTMC is increasing worldwide.Surgery is the primary treatment;however,prophylactic central lymph node dissection is controversial,and discrepancies between different guidelines have been noted.Routine prophylactic central lymph node dissection may result in hypoparathyroidism and recurrent laryngeal nerve injury in some patients without lymph node metastasis,while simple thyroidectomy may leave metastatic lymph nodes in high-risk patients.To selectively perform prophylactic lymph node dissections in high-risk patients,it is important to identify predictive factors for lymph node metastases in patients with PTMC.Several studies have reported on this,but their conclusions are not entirely consistent.Several clinicopathologic characteristics have been identified as risk factors for central lymph node metastases,and the most commonly reported factors include age,gender,tumor size and location,multifocality,bilaterality,extrathyroidal extension,and abnormal lymph node found using ultrasound.Here,we provide an overview of previous studies along with a favorable opinion on or against these factors,with the aim of increasing the understanding of this topic among the medical community.In addition,current opinions about prophylactic central lymph node dissection are reviewed and discussed.展开更多
Papillary thyroid carcinoma(PTC) is the most common thyroid malignancy, accounting for approximatley 90% of thyroid malignancies in areas of the world without deficit of Iodine. It's universally accepted that tota...Papillary thyroid carcinoma(PTC) is the most common thyroid malignancy, accounting for approximatley 90% of thyroid malignancies in areas of the world without deficit of Iodine. It's universally accepted that total thyroidectomy is the minimal surgical treatment for patients with PTC higher than 1 cm. When a quality surgery is performed, the prognosis for PTC is excellent with 10 and 20-year overall survival rates around 90% and 85%, respectively. Lymph node metastases are very frequent in PTC, occurring in 50%-80% of PTC patients, the most of them being located in the central compartment of the neck(CCN) and with a high rate of occult or clinically undetectable disease. A lot of controversy exists regarding how to treat the central nodal compartment disease of PTC. The first problem is the lack of standardization of the terminology and concepts related to the CCN, which are clearly established and defined in this paper according to the most recent consensus documents of endocrine societies. This uniformity will provide a more consistent and clear communicaction between all the specialist involved in the treatment of PTC. CCN can be performed to treat patients with clinically detectable, radiologically suspected of intraoperative visualized nodal disease(this is defined as therapeutic) or when these findings are absent(also called prophylactic). Indicactions, advantages and disadvantages of both therapeutic and prophylactic CCN dissection are widely discussed and clear recommendations provided.展开更多
基金Fundamental Research Funds for the Central Universities of China,No.3332019022.
文摘Papillary thyroid microcarcinoma(PTMC)measures 1 cm or less in its longest dimension.The incidence of PTMC is increasing worldwide.Surgery is the primary treatment;however,prophylactic central lymph node dissection is controversial,and discrepancies between different guidelines have been noted.Routine prophylactic central lymph node dissection may result in hypoparathyroidism and recurrent laryngeal nerve injury in some patients without lymph node metastasis,while simple thyroidectomy may leave metastatic lymph nodes in high-risk patients.To selectively perform prophylactic lymph node dissections in high-risk patients,it is important to identify predictive factors for lymph node metastases in patients with PTMC.Several studies have reported on this,but their conclusions are not entirely consistent.Several clinicopathologic characteristics have been identified as risk factors for central lymph node metastases,and the most commonly reported factors include age,gender,tumor size and location,multifocality,bilaterality,extrathyroidal extension,and abnormal lymph node found using ultrasound.Here,we provide an overview of previous studies along with a favorable opinion on or against these factors,with the aim of increasing the understanding of this topic among the medical community.In addition,current opinions about prophylactic central lymph node dissection are reviewed and discussed.
文摘Papillary thyroid carcinoma(PTC) is the most common thyroid malignancy, accounting for approximatley 90% of thyroid malignancies in areas of the world without deficit of Iodine. It's universally accepted that total thyroidectomy is the minimal surgical treatment for patients with PTC higher than 1 cm. When a quality surgery is performed, the prognosis for PTC is excellent with 10 and 20-year overall survival rates around 90% and 85%, respectively. Lymph node metastases are very frequent in PTC, occurring in 50%-80% of PTC patients, the most of them being located in the central compartment of the neck(CCN) and with a high rate of occult or clinically undetectable disease. A lot of controversy exists regarding how to treat the central nodal compartment disease of PTC. The first problem is the lack of standardization of the terminology and concepts related to the CCN, which are clearly established and defined in this paper according to the most recent consensus documents of endocrine societies. This uniformity will provide a more consistent and clear communicaction between all the specialist involved in the treatment of PTC. CCN can be performed to treat patients with clinically detectable, radiologically suspected of intraoperative visualized nodal disease(this is defined as therapeutic) or when these findings are absent(also called prophylactic). Indicactions, advantages and disadvantages of both therapeutic and prophylactic CCN dissection are widely discussed and clear recommendations provided.
