Risk of cervical lymph node metastasis in papillary thyroid carcinoma: Correlations with lymphangiogenesis and ultrasound features
임파선 전이 갑상선 유두암에 있어서 lymphangiogenesis와 초음파소견의 연관성
- 발행기관 아주대학교
- 지도교수 박경주
- 발행년도 2013
- 학위수여년월 2013. 2
- 학위명 박사
- 학과 및 전공 일반대학원 의학과
- 실제URI http://www.dcollection.net/handler/ajou/000000013460
- 본문언어 영어
- 저작권 아주대학교 논문은 저작권에 의해 보호받습니다.
초록/요약
Stratification of risk factors for cervical lymph node metastasis (LNM) in thyroid papillary carcinoma is important for providing standards for post-operative adjuvant radio-iodine therapy and for predicting patient prognosis. We investigated pathological factors based on the lymphatic vessel system and ultrasound features associated with tumor with cervical LNM. Among patients who had undergone thyroidectomy confirmed to be papillary thyroid carcinoma, we selected 126 age-sex matched paired patients without cervical LNM (group 1) and with LNM (group 2) to evaluate risk factors. Pathological factors evaluated were size, multiplicity, and extra thyroid extension state, based on the pathological reports using stored data. The lymphatic vessel density (LVD) of each tumor was evaluated by staining for VEGFR-3 and D2-40 and correlated with cervical LNM state. Ultrasound features were evaluated to compare the differences between these two groups. Larger tumor size, multiplicity, extrathyroid extension were more common in group 2 (p<0.05). The median percentage of VEGFR-3 for group 1 was 20 (range 0-30) and D2-40 was 13 (range 7-23) while for group 2, VEGFR-3 was 80 (70-90) and D2-40 was 78 (54-114). LVD measured by intratumoral D2-40 staining was 20.6% and 79.4% for group 1 and group 2, respectively. Intra-tumoral lymphatics measured by D2-40 stain had a strong correlation with cervical LNM (Odds 1.230, CI 1.01.-1.499 p value 0.040). US features had no significant differences between the two groups although calcifications tended to be higher in group 2 (84% vs 76% p=0.264). Lymphatic vessel density and nodule echogenicity did not show correlations. Intratumoral lymphangiogenesis was most strongly associated with LNM and thus, could be a useful predictive marker for cervical LNM.
more목차
ABSTRACT i
TALBLE OF CONTENTS ⅲ
LIST OF FIGURES AND TABLES ⅳ
ABBREVIATION ⅴ
Ⅰ. INTRODUCTION 1
Ⅱ. MATERIALS AND METHODS 3
1. Patient Selection 3
2. Immunohistochemistry 4
3. Imaging and Imaging Analysis 10
4. Statistical Analysis 11
Ⅲ. RESULTS 12
1. Univariate analysis 12
2. Multivariate analysis 14
3. Imaging analysis 16
Ⅳ. DISCUSSION 20
Ⅴ. CONCLUSION 25
REFERENCES 26
국문 요약 32
