Objective: To investigate the clinical value of intraoperative frozen section analysis for prelaryngeal/Delphian lymph nodes (DLN) and pretracheal lymph nodes (PLN) in surgery for papillary thyroid carcinoma (PTC).
Methods: The clinical data of 245 patients with PTC diagnosed by preoperative fine-needle aspiration biopsy and accepted the first-time surgery in the Department of Thyroid and Breast Surgery of the Second Affiliated Hospital, Kunming Medical University from January 2015 to December 2016 were collected. All patients underwent intraoperative frozen section examination for both DLN and PLN, and then surgical procedures were decided according to the metastasis status of the DLN and PLN.
Results: DLN and PLN were detected in the intraoperative frozen sections for all the 245 patients, with the number of lymph nodes ranged from 2 to 11, and DLN and PLN metastases were found in 126 patients (51.43%). Paratracheal lymph node metastases were found in 165 patients, and lateral cervical metastases were found in
26 patients by postoperative pathological examination. Seventy-six patients underwent unilateral lobectomy with isthmusectomy plus ipsilateral central neck dissection, 42 patients underwent total thyroidectomy plus central neck dissection of the affected side, 101 patients underwent total thyroidectomy plus bilateral central neck dissection, and 26 patients underwent total thyroidectomy plus bilateral central neck dissection along with lateral neck dissection. Results of statistical analyses demonstrated that capsular invasion was an independent risk factor for DLN and PLN metastases (OR=9.62, P=0.021).
Conclusion: DLN and PLN can be considered as the sentinel lymph nodes of PTC, and their metastases are closely related to paratracheal lymph node and lateral cervical lymph node metastases. The intraoperative frozen section examination for DLN and PLN will help to choose the best surgical procedure and thereby provide more precise treatment for PTC.