【摘要】 目的:探索在甲状腺乳头状癌中纳米炭示踪侧颈部淋巴结的应用价值。方法:前瞻性地入组2016年3月至2017年11月复旦大学附属肿瘤医院接受甲状腺癌手术患者,术前超声或CT提示侧颈部淋巴结可疑转移,术中应用纳米炭混悬注射液进行侧颈部淋巴结示踪。结果:共67例患者接受了70例/侧颈部淋巴结示踪手术,侧颈部淋巴结转移57例(81.4%)。炭阳性淋巴结的中位检出数量为6枚。Ⅳ区炭染淋巴结无论在送检例数、送检淋巴结枚数以及转移淋巴结比例均为最高。Ⅲ～Ⅳ区淋巴结中炭阳性淋巴结的转移比例显著高于炭阴性淋巴结(P<0.001)。将最终颈清扫结果作为金标准,计算Ⅲ～Ⅳ区炭阳性淋巴结活检敏感度为86.0%。结论:纳米炭是甲状腺癌侧颈部淋巴结示踪的潜在方法。联合侧颈部Ⅲ～Ⅳ区炭阳性淋巴结活检,可以达到较高的敏感度,是较为合理的前哨淋巴结活检范围。更多还原

【Abstract】 Objective: To explore the value of nanoparticles(CN) in lateral cervical lymph node mapping in papillary thyroid carcinoma using carbon. Methods: Thyroid cancer patients with suspicious lymph node metastasis but without typical signs of metastatic disease from March2016 to November 2017 in Fudan University Shanghai Cancer Center were prospectively included in the cohort. Neck dissection was performed in all patients(compartments Ⅱ-Ⅴ). Suspicious lateral lymph node metastasis was identified using pre-operative ultrasound or computed tomography. CN were used for lymph node mapping during surgery. Results: A total of 70 surgeries were performed in 67 patients, among which 57 were found to have lateral lymph node metastasis(81.4%). The median number of CN-dyed lateral lymph nodes was 6. Compartment Ⅳ had the highest number of CN-dyed positive lymph nodes as well as the highest rate of metastasis, followed by compartment Ⅲ. In compartments Ⅲ and Ⅳ, the incidence of lymph node metastasis was significantly higher in the CN-dyed group than in the CN-undyed group(P<0.001). When the final pathology of neck dissection was set as the gold standard, lateral CN-dyed lymph node biopsy was found to have a sensitivity of 86.0%; its negative predictive value was 61.9% and its overall accuracy was 88.6%. Conclusions:Injection of CN during surgery was a potential method of mapping lateral lymph nodes in papillary thyroid carcinoma. Compartment Ⅲ-Ⅳ CN-dyed lymph node biopsy had a satisfactory sensitivity and thus, served as a reasonable range for lymph node biopsy.更多还原