International journal of surgery (London, England) · 2025
Navigating the lymphatic labyrinth: insights into lateral cervical metastasis patterns in papillary thyroid carcinoma a multicenter study.
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Cai Taonong, Jiao Zan, Guo Yu, Yu Yongchao, Ning Kang, Zou Bu, Jiang Mingjie, Yang Zhongyuan, Liu Tianrun, Chen Weichao, Wu Tong, Yang Ankui
Аннотация
INTRODUCTION: Papillary thyroid carcinoma (PTC) often spreads to lateral cervical lymph nodes (LNs), but research on their distribution and drainage is limited. Delphian lymph node (DLN) metastasis is a key indicator of regional lymph node (LN) involvement and recurrence in PTC, yet its exact role in predicting regional LN metastasis and its effect on other regional LNs is unclear.
METHODS: A total of 3,356 patients who had surgery at ***, ***, and *** were enrolled. PTC subspecialized pathologists independently evaluated the primary tumors and eight regions of the involved LNs. T test, Chi-square test, Kaplan-Meier survival analysis, propensity-score matching, and multivariate Cox regression were used.
RESULTS: This study is the first to propose a reticular structure model for lateral cervical LNs, with each region being interconnected, first-station LN metastasis may occur within any of these regions, and we conduct a mapping of LN metastasis. In addition, compared to DLN- patients, DLN + patients had a significantly higher rate of metastasis in both central and lateral cervical regions. There was a notable rise in metastatic regions, total metastatic LNs, and particularly contralateral cervical metastasis in DLN + patients. DLN exhibit a close relationship with other regional lymph nodes and play a significant role in prognostic assessments. Researchers further discussed the correlation between the DLN and lateral cervical LNs, providing anatomical evidence for this association: the DLN positioned at the hub of lateral cervical LNs reticular structure, functions as a hub connecting with other LNs.
CONCLUSION: This study focuses on the reticular structure of cervical LNs, identifying the DLN as the central component of this structure, with significant connectivity to other Levels.
METHODS: A total of 3,356 patients who had surgery at ***, ***, and *** were enrolled. PTC subspecialized pathologists independently evaluated the primary tumors and eight regions of the involved LNs. T test, Chi-square test, Kaplan-Meier survival analysis, propensity-score matching, and multivariate Cox regression were used.
RESULTS: This study is the first to propose a reticular structure model for lateral cervical LNs, with each region being interconnected, first-station LN metastasis may occur within any of these regions, and we conduct a mapping of LN metastasis. In addition, compared to DLN- patients, DLN + patients had a significantly higher rate of metastasis in both central and lateral cervical regions. There was a notable rise in metastatic regions, total metastatic LNs, and particularly contralateral cervical metastasis in DLN + patients. DLN exhibit a close relationship with other regional lymph nodes and play a significant role in prognostic assessments. Researchers further discussed the correlation between the DLN and lateral cervical LNs, providing anatomical evidence for this association: the DLN positioned at the hub of lateral cervical LNs reticular structure, functions as a hub connecting with other LNs.
CONCLUSION: This study focuses on the reticular structure of cervical LNs, identifying the DLN as the central component of this structure, with significant connectivity to other Levels.