Diagnosis and treatment of occult carcinoma of the thyroid with neck lymph node metastasis as the first symptom_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HU Hongsheng , SUN Shaohua , SHEN Feng , WU Hongwei , ZHANG Zhen , FANG Dazheng ,  ZHOU Wenbo

Thyroid Diagnosis and Treatment Center, Dongfeng Hospital of Hubei University of Medicine, Shiyan, Hubei 442008, P.R.China;

Corresponding?author：

ZHOU Wenbo, Email: zwbmail@163.com

Keywords：

occult carcinoma of the thyroid; neck lymph node metastasis; the first symptom; diagnosis; treatment

DOI：

10.7507/1007-9424.201608026

Video：

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Objective To investigate the optimal diagnosis and treatment strategy of occult carcinoma of the thyroid (OCT) with neck lymph node metastasis as the first symptom. Method In order to discuss the optimal diagnosis and treatment strategy of OCT with neck lymph node metastasis as the first symptom, we collected 35 cases and analyzed their characteristics, diagnostic methods, operative schemes, metastasis situation, and death situation. Results Of the 35 cases, 28 cases went to hospital because of swollen lymph nodes, and other 7 cases were discovered by color Doppler ultrasound in medical examination. Thyroid nodules were found by color Doppler ultrasound in 32 cases, 3 cases were found no thyroid nodule. Lymph node of 23 cases were determined by ultrasound-guided fine-needle aspiration biopsy (US-FNAB), and 16 cases (69.56%) were diagnosed as metastasis of thyroid carcinoma or suspicious metastasis by US-FNAB. Thyroid biopsy were done in 21 cases, and 11 cases (52.38%) were diagnosed as thyroid carcinoma or suspicious thyroid carcinoma by fine needle aspiration biopsy. Of the 35 cases, 19 cases were performed total thyroidectomy and functional neck lymph node dissection, 11 cases were performed resection of unilateral thyroid and isthmus and regional neck lymph node dissection, 5 cases were performed nonstandard operations. All cases were followed up for 3–10 years after operation, and the median time was 7-year. During follow up period, 10 cases suffered from reccurrence. Among them, 3 cases reoccurred in the nonstandard operation group, 5 cases reoccurred in resection of unilateral thyroid and isthmus and regional neck lymph node dissection group, 3 cases reoccurred in total thyroidectomy and functional neck lymph node dissection group. There were 3 cases died. Among them, there was 1 case in each group of nonstandard operation group, resection of unilateral thyroid and isthmus and regional neck lymph node dissection group, and total thyroidectomy and functional neck lymph node dissection group. The recurrence rate of total thyroidectomy and functional neck lymph node dissection group was markedly lower than those of resection of unilateral thyroid and isthmus and regional neck dissection group (χ²=4.751,P<0.05) and nonstandard operation group (χ²=5.874,P<0.05). While there was no significance difference of the recurrence rate between the resection of unilateral thyroid and isthmus and regional neck dissection group and nonstandard operation group (χ²=0.291,P>0.05). There was no significance difference in the mortality among the three groups (P>0.05). Conclusion US-FNAB and intraoperation rapid frozen pathological section are important methods for diagnosis of OCT with neck lymph node metastasis as the first symptom, and standard operation is an principal treatment method for it.

Citation： HU Hongsheng, SUN Shaohua, SHEN Feng, WU Hongwei, ZHANG Zhen, FANG Dazheng, ZHOU Wenbo. Diagnosis and treatment of occult carcinoma of the thyroid with neck lymph node metastasis as the first symptom. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(3): 355-360. doi: 10.7507/1007-9424.201608026 Copy

1.	蘇汝康, 郭斌. 54 例隱匿性甲狀腺癌診治的回顧性分析. 中國中西醫結合外科雜志, 2014, 20(1): 21-24.
2.	賀曉斌, 賀寶艷, 陳武科, 等. 隱匿性甲狀腺癌的診斷及手術治療(附 68 例報告). 現代腫瘤醫學, 2012, 2(2): 274-276.
3.	胡洪生, 周文波, 孫少華, 等. 甲狀腺癌頸部淋巴結轉移彩超特點分析. 湖北醫藥學院學報, 2015, 34(2): 155-158.
4.	American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer; Cooper DS, Doherty GM, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 2009, 19(11): 1167-1214.
5.	全麗娟, 朱文軍, 孟彬, 等. 甲狀腺微小乳頭狀癌超聲聲像圖特征預測頸部淋巴結轉移的價值. 中國臨床醫學影像雜志, 2013, 24(4): 272-274.
6.	許莉華, 黃斌. 高頻超聲在甲狀腺囊實性結節良惡性鑒別中的應用. 中國現代醫生, 2016, 54(1): 126-128.
7.	彭玉蘭, 馬步云, 于波洋, 等. 甲狀腺微小癌的超聲研究現狀與進展. 西部醫學, 2016, 28(4): 448-452.
8.	王剛, 楊超, 李大強, 等. 高頻超聲檢查甲狀腺乳頭狀癌超聲圖像的特征分析. 中國腫瘤臨床與康復, 2015, 22(10): 1192-1193.
9.	Remonti LR, Kramer CK, Leit?o CB, et al. Thyroid ultrasound features and risk of carcinoma: a systematic review and meta-analysis of observational studies. Thyroid, 2015, 25(5): 538-550.
10.	汪宏梅. 133例頸部淋巴結細針穿刺細胞學分析. 西部醫學, 2012, 24(7): 1377-1378.
11.	Khan S, Omar T, Michelow P. Effectiveness of the cell block technique in diagnostic cytopathology. J Cytol, 2012, 29(3): 177-182.
12.	宣之東, 鄭雪, 周利. 超聲引導下淺表淋巴結細針穿刺活檢的臨床應用. 疑難病雜志, 2014, 13(5): 494-496.
13.	劉曉暉, 華璽, 丁鵬, 等. 超聲引導下頸淋巴結穿刺活檢對甲狀腺癌診斷的臨床價值. 實用癌癥雜志, 2016, 31(7): 1911-1913.
14.	National Comprehensive Cancer Network. NCCN clinical practice guidelines for treatment of cancer: thyroid carcinoma V. 2. 2015. 2016-03-15. http://www.nccn.org/professionals/physician_gls/ pdf/thyroid.pdf.
15.	Haugen BR, Alexander EK, Bible KC, et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid, 2016, 26(1): 1-133.
16.	Perros P, Boelaert K, Colley S, et al. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf), 2014, 81 Suppl 1: 1-122.
17.	Dean DS, Gharib H. Fine-needle aspiration biopsy of the thyroid gland. 2015-04-26. https://www.ncbi.nlm.nih.gov/books/ NBK285544/.
18.	孫輝, 劉曉莉. 甲狀腺癌規范化診治理念更新及其意義. 中國實用外科雜志, 2015, 35(1): 72-75.
19.	趙彥廣. 隱匿性甲狀腺癌的臨床診治//中國抗癌協會甲狀腺癌專業委員會, 中國抗癌協會頭頸腫瘤專業委員會, 中華醫學會腫瘤分會頭頸學組. 2014第六屆全國甲狀腺腫瘤學術大會論文集. 中國天津, 2014.
20.	Yang GC, LiVolsi VA, Baloch ZW. Thyroid microcarcinoma: fine-needle aspiration diagnosis and histologic follow-up. Int J Surg Pathol, 2002, 10(2): 133-139.
21.	Boucek J, Kastner J, Skrivan J. Occult thyroid carcinoma . Acta Otorhinolaryngol Ital, 2009, 29(6): 296-304.
22.	Piana S, Ragazzi M, Tallini G, et al. Papillary thyroid microcarcinoma with fatal outcome evidence of tumor progression in lymph node metastases. Hum Pathol, 2013, 44(4): 556-565.
23.	張強, 張侖, 宋方方, 等. 甲狀腺乳頭狀癌頸部淋巴結轉移規律臨床分析. 中國耳鼻咽喉頭頸外科, 2010, 1(12): 639-642.
24.	姜軍, 李世超. 分化型甲狀腺癌淋巴結轉移特點及頸側方淋巴結清掃術局部應用解剖. 中國實用外科雜志, 2011, 31(5): 380-383.
25.	張臥, 羅定存. 頸側區淋巴結轉移陽性甲狀腺乳頭狀癌頸淋巴結轉移規律分析. 現代實用醫學, 2012, 24(10): 1135-1136.
26.	劉妍, 景尚華. 甲狀腺微小癌的診斷與治療進展. 實用癌癥雜志, 2016, 31(1): 171-173.
27.	趙朋, 蘇新良. 甲狀腺微小乳頭狀癌治療方式探討. 現代醫藥衛生, 2016, 32(6): 858-860.
28.	Macedo FI, Mittal VK. Total thyroidectomyversus lobectomy as initial operation for small unilateral papillary thyroid carcinoma: a meta-analysis. Surg Oncol, 2015, 24(2): 117-122.
29.	胡洪生, 周文波, 沈豐, 等. 甲狀腺乳頭狀癌合并髓樣癌1例報告. 中國實用外科雜志, 2015, 35(2): 234, 236.

1. 蘇汝康, 郭斌. 54 例隱匿性甲狀腺癌診治的回顧性分析. 中國中西醫結合外科雜志, 2014, 20(1): 21-24.
2. 賀曉斌, 賀寶艷, 陳武科, 等. 隱匿性甲狀腺癌的診斷及手術治療(附 68 例報告). 現代腫瘤醫學, 2012, 2(2): 274-276.
3. 胡洪生, 周文波, 孫少華, 等. 甲狀腺癌頸部淋巴結轉移彩超特點分析. 湖北醫藥學院學報, 2015, 34(2): 155-158.
4. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer; Cooper DS, Doherty GM, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 2009, 19(11): 1167-1214.
5. 全麗娟, 朱文軍, 孟彬, 等. 甲狀腺微小乳頭狀癌超聲聲像圖特征預測頸部淋巴結轉移的價值. 中國臨床醫學影像雜志, 2013, 24(4): 272-274.
6. 許莉華, 黃斌. 高頻超聲在甲狀腺囊實性結節良惡性鑒別中的應用. 中國現代醫生, 2016, 54(1): 126-128.
7. 彭玉蘭, 馬步云, 于波洋, 等. 甲狀腺微小癌的超聲研究現狀與進展. 西部醫學, 2016, 28(4): 448-452.
8. 王剛, 楊超, 李大強, 等. 高頻超聲檢查甲狀腺乳頭狀癌超聲圖像的特征分析. 中國腫瘤臨床與康復, 2015, 22(10): 1192-1193.
9. Remonti LR, Kramer CK, Leit?o CB, et al. Thyroid ultrasound features and risk of carcinoma: a systematic review and meta-analysis of observational studies. Thyroid, 2015, 25(5): 538-550.
10. 汪宏梅. 133例頸部淋巴結細針穿刺細胞學分析. 西部醫學, 2012, 24(7): 1377-1378.
11. Khan S, Omar T, Michelow P. Effectiveness of the cell block technique in diagnostic cytopathology. J Cytol, 2012, 29(3): 177-182.
12. 宣之東, 鄭雪, 周利. 超聲引導下淺表淋巴結細針穿刺活檢的臨床應用. 疑難病雜志, 2014, 13(5): 494-496.
13. 劉曉暉, 華璽, 丁鵬, 等. 超聲引導下頸淋巴結穿刺活檢對甲狀腺癌診斷的臨床價值. 實用癌癥雜志, 2016, 31(7): 1911-1913.
14. National Comprehensive Cancer Network. NCCN clinical practice guidelines for treatment of cancer: thyroid carcinoma V. 2. 2015. 2016-03-15. http://www.nccn.org/professionals/physician_gls/ pdf/thyroid.pdf.
15. Haugen BR, Alexander EK, Bible KC, et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid, 2016, 26(1): 1-133.
16. Perros P, Boelaert K, Colley S, et al. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf), 2014, 81 Suppl 1: 1-122.
17. Dean DS, Gharib H. Fine-needle aspiration biopsy of the thyroid gland. 2015-04-26. https://www.ncbi.nlm.nih.gov/books/ NBK285544/.
18. 孫輝, 劉曉莉. 甲狀腺癌規范化診治理念更新及其意義. 中國實用外科雜志, 2015, 35(1): 72-75.
19. 趙彥廣. 隱匿性甲狀腺癌的臨床診治//中國抗癌協會甲狀腺癌專業委員會, 中國抗癌協會頭頸腫瘤專業委員會, 中華醫學會腫瘤分會頭頸學組. 2014第六屆全國甲狀腺腫瘤學術大會論文集. 中國天津, 2014.
20. Yang GC, LiVolsi VA, Baloch ZW. Thyroid microcarcinoma: fine-needle aspiration diagnosis and histologic follow-up. Int J Surg Pathol, 2002, 10(2): 133-139.
21. Boucek J, Kastner J, Skrivan J. Occult thyroid carcinoma . Acta Otorhinolaryngol Ital, 2009, 29(6): 296-304.
22. Piana S, Ragazzi M, Tallini G, et al. Papillary thyroid microcarcinoma with fatal outcome evidence of tumor progression in lymph node metastases. Hum Pathol, 2013, 44(4): 556-565.
23. 張強, 張侖, 宋方方, 等. 甲狀腺乳頭狀癌頸部淋巴結轉移規律臨床分析. 中國耳鼻咽喉頭頸外科, 2010, 1(12): 639-642.
24. 姜軍, 李世超. 分化型甲狀腺癌淋巴結轉移特點及頸側方淋巴結清掃術局部應用解剖. 中國實用外科雜志, 2011, 31(5): 380-383.
25. 張臥, 羅定存. 頸側區淋巴結轉移陽性甲狀腺乳頭狀癌頸淋巴結轉移規律分析. 現代實用醫學, 2012, 24(10): 1135-1136.
26. 劉妍, 景尚華. 甲狀腺微小癌的診斷與治療進展. 實用癌癥雜志, 2016, 31(1): 171-173.
27. 趙朋, 蘇新良. 甲狀腺微小乳頭狀癌治療方式探討. 現代醫藥衛生, 2016, 32(6): 858-860.
28. Macedo FI, Mittal VK. Total thyroidectomyversus lobectomy as initial operation for small unilateral papillary thyroid carcinoma: a meta-analysis. Surg Oncol, 2015, 24(2): 117-122.
29. 胡洪生, 周文波, 沈豐, 等. 甲狀腺乳頭狀癌合并髓樣癌1例報告. 中國實用外科雜志, 2015, 35(2): 234, 236.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Diagnosis and treatment of occult carcinoma of the thyroid with neck lymph node metastasis as the first symptom

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