Utility of intraoperative Delphian lymph node sampling in pediatric thyroid surgery

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-10-20 DOI:10.1016/j.ijporl.2024.112144

Monica S. Trent , Brooke M. Su-Velez , Gurpreet Ahuja , Kevin Huoh

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引用次数: 0

Abstract

Objectives

The Delphian lymph node (DLN) is the first lymph node receiving drainage from the thyroid. We aim to determine whether routine DLN sampling with frozen section analysis during pediatric thyroidectomy can alter intraoperative surgical decision making. Additionally, we aim to measure whether DLNs can predict a requirement for central neck dissection (CND) in the clinically node negative (CNN) pediatric population.

Methods

Retrospective chart review for pediatric patients who underwent thyroidectomy between 2014 and 2022. Patients were included if they had prior FNA with a result of: benign nodule, atypia or follicular neoplasm of undetermined significance (AUS/FNUS), follicular neoplasm (FN), or papillary thyroid carcinoma (PTC). All patients had intraoperative DLN analysis via frozen section histopathology.

Results

27 patients were included, 9 males (33 %) and 18 females (67 %). On final pathology 19 patients (70.4 %) had PTC. The DLN was negative for carcinoma in all (n = 8, 100 %) patients with benign pathology. In 10 patients (100 %) with positive DLN on frozen section, postoperative pathology demonstrated central neck metastasis. Nine (90 %) of these patients were CNN and had alterations in the surgical plan based on the DLN. The tenth patient's surgical plan did not change given preoperative clinical disease. Three patients with negative DLNs had central neck metastasis.

Conclusion

The DLN serves a role in guiding treatment for the pediatric population. Positive DLN altered surgical plans in 60 % of CNN PTC patients, allowing for CND to be performed and reducing need for additional surgical resection. The positive predictive value for DLN status was 100 % in this study, and the negative predictive value was 62.5 %. However, negative DLNs do not rule out central neck disease.

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术中德尔菲淋巴结取样在小儿甲状腺手术中的应用。

目标德尔斐淋巴结（DLN）是接受甲状腺引流的第一个淋巴结。我们旨在确定在小儿甲状腺切除术中通过冰冻切片分析对 DLN 进行常规取样是否能改变术中手术决策。此外，我们还想了解 DLN 是否能预测临床结节阴性（CNN）儿科患者是否需要进行颈部中央切除术（CND）：方法：对2014年至2022年间接受甲状腺切除术的儿科患者进行回顾性病历审查。如果患者之前的FNA检查结果为：良性结节、不典型或意义未定的滤泡性肿瘤（AUS/FNUS）、滤泡性肿瘤（FN）或甲状腺乳头状癌（PTC），则将其纳入检查范围。所有患者都在术中通过冰冻切片组织病理学进行了 DLN 分析。结果：共纳入 27 例患者，其中男性 9 例（33%），女性 18 例（67%）。最终病理结果显示，19 名患者（70.4%）患有 PTC。所有良性病变患者（8 人，100%）的 DLN 均为阴性。在冰冻切片 DLN 呈阳性的 10 名患者（100%）中，术后病理结果显示为颈部中心转移。其中九名患者（90%）为 CNN 患者，并根据 DLN 改变了手术方案。第十位患者的手术方案没有因术前临床疾病而改变。3名DLN阴性的患者出现颈部中心转移：结论：DLN对儿童患者的治疗具有指导作用。DLN阳性改变了60%的CNN PTC患者的手术计划，使CND得以实施，并减少了额外手术切除的需要。在这项研究中，DLN 状态的阳性预测值为 100%，阴性预测值为 62.5%。然而，阴性 DLN 并不能排除颈部中心性疾病。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.