갑상선 유두암 환자에서 Level II 림프절 전이의 예측인자 (Predictive Factors of Level II Lymph Node Metastasis in N1b Papillary Thyroid Carcinoma Patients)

서지정보

· 발행기관 : 대한이비인후과학회
· 수록지 정보 : 대한이비인후-두경부외과학회지 / 52권 / 11호 / 899 ~ 904페이지
· 저자명 : 조계송, 한명월, 김상윤, 남순열, 노종렬, 최승호

초록

Background and Objectives Cervical lymph node (LN) metastases are common in papillary
thyroid carcinoma (PTC) and cervical neck dissection (ND) is frequently performed to improve
regional control of the disease. However, there is a controversy as to the extent of lateral
cervical ND. In the present study, we examined the diagnostic accuracy of ultrasonography
(US) or CT and the predictive factors of level II LN metastases in PTC patients with clinically
positive lateral neck nodes.
Subjects and Method We retrospectively analyzed 78 patients who underwent thyroidectomy
and lateral ND including level II LN between August 1998 to June 2008. To identify predictive
factors of cervical node metastases to level II, diverse factors were analyzed.
Results The most common site of metastasis was level IV (83.3% of cases). The accuracy
of diagnostic imaging in the detection of level II metastasis revealed sensitivity of 89.4%, and
specificity of 93.5%. The results of the univariate analysis showed that the presence of level II
metastases was significantly associated with the location of primary tumor (p<0.001), number
of metastatic LN (p=0.001), and great size of metastatic LN (p=0.010). In addition, the multivariate
analysis showed that the location of primary tumor and number of metastatic LN were
an independent risk factor for the presence of level II metastasis.
Conclusion Preoperative imaging was accurate for detecting the presence of level II LN metastasis.
Patients with upper lobe tumor and multiple metastatic LN have a higher risk of harboring
metastatic disease at the level II. We suggest that routine dissection of the level II LN may
not be necessary for patients with no evidence of diagnostic imaging and predictive factors of
level II LN metastasis.

영어초록

Background and Objectives Cervical lymph node (LN) metastases are common in papillary
thyroid carcinoma (PTC) and cervical neck dissection (ND) is frequently performed to improve
regional control of the disease. However, there is a controversy as to the extent of lateral
cervical ND. In the present study, we examined the diagnostic accuracy of ultrasonography
(US) or CT and the predictive factors of level II LN metastases in PTC patients with clinically
positive lateral neck nodes.
Subjects and Method We retrospectively analyzed 78 patients who underwent thyroidectomy
and lateral ND including level II LN between August 1998 to June 2008. To identify predictive
factors of cervical node metastases to level II, diverse factors were analyzed.
Results The most common site of metastasis was level IV (83.3% of cases). The accuracy
of diagnostic imaging in the detection of level II metastasis revealed sensitivity of 89.4%, and
specificity of 93.5%. The results of the univariate analysis showed that the presence of level II
metastases was significantly associated with the location of primary tumor (p<0.001), number
of metastatic LN (p=0.001), and great size of metastatic LN (p=0.010). In addition, the multivariate
analysis showed that the location of primary tumor and number of metastatic LN were
an independent risk factor for the presence of level II metastasis.
Conclusion Preoperative imaging was accurate for detecting the presence of level II LN metastasis.
Patients with upper lobe tumor and multiple metastatic LN have a higher risk of harboring
metastatic disease at the level II. We suggest that routine dissection of the level II LN may
not be necessary for patients with no evidence of diagnostic imaging and predictive factors of
level II LN metastasis.

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