目的: 探讨甲状腺微小乳头状癌（papillary thyroid microcarcinoma,PTMC）的临床病理和超声影像特征,并分析其与中央组淋巴结转移间的相关性。方法: 回顾性分析826例甲状腺PTMC患者的临床资料,评估各指标（性别、年龄、肿瘤多灶性、肿瘤最大径、肿瘤双侧性、是否合并慢性淋巴细胞性甲状腺炎）和超声影像特征,并探讨其与颈部淋巴结转移间的相关性。进行单变量和多变量分析,以确定PTMC患者发生颈部淋巴结转移的相关因素。结果: 826例PTMC患者中有216例(26.15%)存在颈部淋巴结转移。单变量和多变量分析显示,患者为男性（OR=1.600,P<0.001）、年龄≤45岁（OR=2.020,P<0.001）、肿瘤最大径>5 mm（OR=2.371,P<0.001）、超声显示病灶内存在微钙化（OR=1.407,P=0.042）是发生颈部淋巴结转移的危险因素;而合并慢性淋巴细胞性甲状腺炎（OR=0.492,P=0.016）则与颈部淋巴结转移的发生呈负相关;肿瘤多灶性、肿瘤双侧性及其余超声特征与颈部淋巴结转移间并无相关性。结论: 男性、年龄≤45岁、肿瘤最大径>5 mm、超声显示病灶内存在微钙化是PTMC发生颈部淋巴结转移的危险因素,可作为颈淋巴结清扫术的参考依据,而合并慢性淋巴细胞性甲状腺炎则可视为颈部淋巴结转移的保护因素。
Objective: To determine the relevant factors for cervical lymph node metastasis (LNM) in papillary thyroid microcarcinoma (PTMC). Methods: A total of 826 patients with pathologically confirmed PTMC at Ruijin Hospital from December 2014 to January 2009 were enrolled. The following factors were assessed for their correlation with the occurrence of cervical LNM, including sex, age, multiple tumor focus, tumor size, bilateral tumor, coexistence of chronic lymphocytic thyroiditis and ultrasonography (US) features. Univariate and multivariate analyses were performed to identify the predicting factors of cervical LNM. Results: Two hundred and sixteen (26.15%) of the 826 patients had cervical LNM. Univariate and multivariate analyses revealed that the following factors were correlated independently with cervical LNM, including male (OR=1.600; P<0.001), ≤45 years of age (OR=2.020; P<0.001), tumor maximum diameter >5 mm (OR=2.371; P<0.001), microcalcification (OR=1.407; P=0.042). Coexistence of chronic lymphocytic thyroiditis (OR=0.492; P=0.016) was a protective factor for cervical lymph node metastasis. Multiple tumor focus, bilateral tumor and other US cha-racteristics were not significantly correlated with the occurrence of cervical LNM. Conclusions: Male, ≤45 years of age, tumor maximum diameter >5 mm and microcalcification are risk factors for the occurrence of cervical LNM in PTMC patient and prophylactic neck dissection should be considered. Coexistence of chronic lymphocytic thyroiditis could be considered as a protective factor for cervical LNM.
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