We all know that differentiated thyroid cancer includes papillary carcinoma and follicular carcinoma, which have a high degree of differentiation. Even if metastasis occurs, most of them have good prognosis after standardized and comprehensive treatment.
Among them, the most common method of transfer is - lymph node metastasis .
So, what should I do after has lymph node metastasis? Is the surgery done by total thyroid or half-cutting? Should I remove unilateral cervical lymph nodes or bilateral? Do Idioxin-131 treatment need? I believe many people want to know questions such as .
Today, I will share it with you in combination with the new guide to treating Chinese Iodine-131 in 2021.
Warm reminder: There is a lot of content, but it is all dry goods . You can choose the content you are interested in to read:
2. How to treat lymph node metastasis?
. How to treat local recurrent lymph nodes?
. There is lymph node metastasis. How to define TNM stage of a methyl carcinoma?
4. There is lymph node metastasis, how to define low, medium and high risk groups?
5. If there is neck lymph node metastasis, should I get iodine-131 clearing the foci treatment?
6. Treatment of lymph node metastasis of differentiated atherosclerosis in children and adolescents.
ultrasound is the preferred method for imaging thyroid nodules. According to the following characteristics, the benign and malignant nature of lymph node can be judged:
. Form. Normal lymph nodes are generally oblong, and those with malignant turn into near-circular shapes, with a ratio of length and short diameters less than 2 (L/T2).
, microcalcification (≤1mm calcification foci ). papillary thyroid carcinoma has a high calcification rate of lymph node metastasis.
4. Intracortical hyperechoics: thyroglobulin deposition is often manifested as hyperechoics, which is a characteristic manifestation of papillary thyroid carcinoma .
5. No echo in the cortex: ultrasound shows no echo or echo translucent area (cystic necrosis), indicating that the infiltration of tumor cells leads to liquefied necrosis.
6, peripheral blood flow signal. is an abnormal hyperplasia of peripheral cortex of malignant lymph nodes, which suggests that it is of strong significance. Normal lymph nodes are esophageal or lack of blood flow.
7, sharp edges. malignant lymph node boundary unclear suggests extracellular infiltration.
8. Surrounding soft tissue edema and lymph node fusion clusters are usually tuberculous.
Summary: Round, calcium, high echo or none, peripheral blood flow indicates malignant tendencies, and short-term enlargement is also suspicious!
. How to treat it if lymph node metastasis is found? Whether there is lymph node metastasis in
determines the surgical method of atarcemia!
lymph node metastasis (N1) and any metastasis lymph node maximum diameter ≥3cm, , regardless of tumor size, , thyroid is recommended.
regional lymph node metastasis or not has less impact on the overall survival and disease-specific survival of differentiated type of atarctic carcinoma, especially papillary carcinoma, , especially in studies with a follow-up time of less than 10 years, it is difficult to see that the difference is statistically significant.However, many studies have shown that whether the cervical lymph node metastasis and whether the regional lymph node dissection of the body can affect the risk of local recurrence. Compared with papillary carcinoma, the lymph node metastasis in follicular carcinoma regional lymph node metastasis has a greater impact on the patient's survival.
In addition, since it is difficult to re-operate after recurrence of the dissection area and the incidence of complications is high, The surgeon must carefully dissect during the first operation to avoid recurrence in the area as much as possible. Standardized regional lymph node dissection is of great significance to reduce local recurrence of the disease.
Regarding the question that has the most debate on , "Whether preventive dissection of lymph nodes in differentiated atarctic cancer region requires preventive dissection", European and American experts and Asian experts have more differences. Experts in Asia, especially in , Japan, South Korea and China are more radical. It is generally believed that although regional lymph node metastasis rarely affects patients' survival, the difference is statistically significant when the follow-up time is long enough and will significantly affect the risk of local recurrence. Reoperative treatment of local recurrence, especially redissection of lymph nodes in the central region, will greatly increase the probability of damage to the recurrent laryngeal nerve and parathyroid gland.
In addition, tumor stage and guidance for subsequent iodine-131 treatment and TSH inhibition treatment can be obtained more clearly after regional lymph node dissection.
Therefore, for clinically suspicious metastatic lymph nodes, especially those confirmed by fine needle aspiration biopsy , , is only located in the central area, is generally recommended for therapeutic central area lymph node dissection or without prophylactic lateral cervical lymph node dissection; when suspicious lymph nodes are only located on the side side cervical cervical lateral, central area lymph node + lymph node dissection or without contralateral cervical lateral cervical lymph node dissection. Although
BRAF gene mutation has a certain impact on the patient's survival and prognosis, it does not have special significance when deciding whether to perform preventive lymph node dissection and scope of dissection.
. How to treat local recurrent lymph nodes?
Up to
For suspicious lesions after surgery, once the fine needle aspiration is clearly metastasized, it is recommended to perform partial or radical cervical lymph node dissection , while non-local resection, because the probability of secondary recurrence after systemic lymph node dissection is significantly reduced.
(1) Due to the previous scar , adhesion, etc., the risk of reoperation is usually higher than the first surgery;
(2) Whether the local recurrent lesions can be completely removed from the surgery. But unlike other malignant tumors, local recurrence or persistent lesions of phat cancer are not contraindications for surgery even with distant organ metastasis. The decision to treat recurrence of lymph nodes in the neck area should take into account the existence and progress of distant lesions. However, in order to alleviate symptoms and prevent the invasion of respiratory obstruction of and important organs such as esophagus and blood vessels, surgical treatment can be performed even if distant metastasis is known. The choice of surgical plan and timing is best for multidisciplinary physicians such as surgery, nuclear medicine , imaging and endocrinology. At the same time, we must fully understand the wishes of the patients and their families and make comprehensive decisions.
However, not all recurrent or persistent differentiated anabolic carcinoma needs immediate surgery once discovered. Some lesions with small load, asymptomatic, and short-term no risk of peripheral soft tissue attack can also be actively observed. The biochemical remission rate of reoperation was 21% to 66%, while the structural remission rate was 51% to 100%.
. There is lymph node metastasis. How to define TNM stage of anaerobic cancer? The TNM stage of
differentiated thyroid carcinoma combines factors such as age, primary tumor size, specific tumor histology, external thyroid diffusion of tumors [direct extrathyroid infiltration, local lymph node metastasis and (or distant metastasis].
Nx: Regional lymph nodes cannot be evaluated
N0: No evidence of lymph node metastasis
N0ah: One or more cytology or histology confirmed benign lymph nodes
N0bhttps://www.sys.com/ ml1: Radiological or clinical evidence of regional lymph node metastasis
N1: Regional lymph node metastasis
N1a: Regional lymph node metastasis Ⅵ and VII zones (pretracheal, paratracheal, pre-laxis/Deiph lymph nodes, superior mediastinal lymph nodes), which can be unilateral or bilateral lesions
N1b: Metastasis to unilateral, bilateral, or contralateral cervical lymph nodes (areas I, II, III, IV, V) or posterior pharyngeal lymph nodes.
4. There is lymph node metastasis, how to define low, medium and high risk groups?
low risk group : cN0 or ≤5 micrometastatic lymph nodes (
medium risk group : cN1 or 5 micrometastatic lymph nodes (maximum diameter is cm) pN1;
high risk group : any metastatic lymph node in pN1 ≥3cm.
55. If there is neck lymph node metastasis, should I get iodine-131 clearing the foci treatment?
- Iodine-131 is one of the effective methods for treating neck lymph node metastasis after phatoma cancer surgery. Especially for those lesions that show better iodine absorption in diagnostic systemic iodine scanning, the effective efficiency of iodine-131 treatment can be as high as 80%, and its therapeutic efficacy is related to the size of metastatic lymph nodes and the iodine absorption ability.
- Although locally possible metastatic lymph nodes have been dissolution during the initial surgical treatment of differentiated atarctic patients, residual lymph node metastasis can often be found in systemic iodine scans. The common areas are area VI, area III and area II of the neck, and the probability is
6. Treatment of lymph node metastasis of differentiated atherosclerosis in children and adolescents.
Although the mortality rate of children and adolescent patients with differentiated pha cancer is lower than that of adults, the lymph node metastasis rate of and the distant metastasis rate are higher when the disease is diagnosed. Therefore, the surgical method and indication of thyroid cancer in children is no different from that of adults.
