scholarly journals Metastatic Risk Profile of Microscopic Lymphatic and Venous Invasion in Medullary Thyroid Cancer

2021 ◽  
Vol 53 (09) ◽  
pp. 588-593
Author(s):  
Andreas Machens ◽  
Kerstin Lorenz ◽  
Frank Weber ◽  
Henning Dralle
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Tumor Size ◽  
Primary Tumor ◽  
Medullary Thyroid Cancer ◽  
Venous Invasion ◽  
Distant Metastases ◽  
Lymphatic Invasion ◽  
Medullary Thyroid ◽  
Primary Tumor Size

AbstractThe metastatic risk profile of microscopic lymphatic and venous invasion in medullary thyroid cancer is ill-defined. This evidence gap calls for evaluation of the suitability of microscopic lymphatic and venous invasion at thyroidectomy for prediction of lymph node and distant metastases in medullary thyroid cancer. In this study of 484 patients with medullary thyroid cancer who had≥5 lymph nodes removed at initial thyroidectomy, microscopic lymphatic and venous invasion were significantly associated with greater primary tumor size (27.6 vs. 14.5 mm, and 30.8 vs. 16.2 mm) and more frequent lymph node metastasis (97.0 vs. 25.9%, and 85.2 vs. 39.5%) and distant metastasis (25.0 vs. 5.1%, and 32.8 vs. 7.3%). Prediction of lymph node metastases by microscopic lymphatic invasion was better than prediction of distant metastases by microscopic venous invasion regarding sensitivity (97.0 vs. 32.8%) and positive predictive value (58.4 vs. 39.2%); comparable regarding negative predictive value (98.5 vs. 90.5%) and accuracy (80.4 vs. 85.1%); and worse regarding specificity (74.1 vs. 92.7%). On multivariable logistic regression, microscopic lymphatic invasion predicted lymph node metastasis better (odds ratio [OR] 65.6) than primary tumor size (OR 4.6 for tumors>40 mm and OR 2.7 for tumors 21–40 mm, relative to tumors≤20 mm), whereas primary tumor size was better in predicting distant metastasis (OR 8.3 for tumors>40 mm and OR 3.9 for tumors 21–40 mm, relative to tumors≤20 mm) than microscopic venous invasion (OR 3.2). These data show that lymphatic invasion predicts lymph node metastases better in medullary thyroid cancer than venous invasion heralds distant metastases.

Exceptionality of Distant Metastases in Node-Negative Hereditary and Sporadic Medullary Thyroid Cancer: Lessons Learned

2021 ◽  
Author(s):  
Andreas Machens ◽  
Kerstin Lorenz ◽  
Frank Weber ◽  
Henning Dralle
Keyword(s):  
Risk Factors ◽  
Thyroid Cancer ◽  
Lymph Node ◽  
Medullary Thyroid Cancer ◽  
Distant Metastases ◽  
Node Negative ◽  
Medullary Thyroid ◽  
Primary Tumor Size ◽  
Node Metastasis ◽  
Node Positive

Abstract Context Risk factors of lymph node and distant metastases have rarely been analyzed in hereditary and sporadic medullary thyroid cancer (MTC) using large genetic-clinical data sets. Objective This comprehensive investigation aimed to explore risk factors of lymph node and distant metastases and interdependencies between age at thyroidectomy, primary tumor size, lymph node metastasis and distant metastasis in patients with hereditary and sporadic MTC. Methods Comparative analyses of risk factors of metastasis, stratified by hereditary MTC (four mutational risk categories) and sporadic MTC. Results There were 1115 patients with hereditary MTC (307 patients) or sporadic MTC (808 patients). Age at thyroidectomy increased proportionately from 12.2, 22.7, 34.3, and 49.8 years for patients with decreasing mutational risk, as compared to 52.1 years for patients with sporadic MTC. Metastatic primary tumors overall were 10.7–19.4 mm larger in node-positive patients and 15.9–19.3 mm larger in distant metastatic patients at thyroidectomy than nonmetastatic tumors. Distant metastases were noted in 13–50% of node-positive vs. 0% of node-negative hereditary MTC, and in 23.5% of node-positive vs. 1.7% of node-negative sporadic MTC. In multivariable logistic regression analysis for sporadic MTC, lymph node metastasis contributed to distant metastasis (odds ratio 12.4) more than primary tumor size (odds ratios of 7.8, 5.5 and 2.4 for tumors measuring >60, 41–60 and 21–40 mm). Conclusions When thyroidectomy is performed before lymph node metastases have developed, distant metastases are exceptional, both in patients with hereditary MTC, irrespective of the level of mutational risk, and patients with sporadic MTC.

A nomogram to predict nonsentinel lymph node involvement in breast cancer patients with sentinel lymph node metastases.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 14-14
Author(s):  
Y. Kojima ◽  
K. Tsugawa ◽  
K. Enokido ◽  
H. Iwata ◽  
S. Ohno ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Multivariate Analysis ◽  
Lymph Node ◽  
Cancer Patients ◽  
Predictive Factors ◽  
Tumor Size ◽  
Primary Tumor ◽  
Lymphatic Invasion ◽  
Breast Cancer Patients ◽  
Primary Tumor Size

14 Background: Several nomograms have been described as predictors of non-sentinel axially lymph node (non-SN) metastases in breast cancer with positive sentinel nodes (SN). However, all these predicting models were based on data from western countries. The purpose of this study was to examine predictive factors of non-SN status among SN metastatic patients, in order to develop a nomogram based on Japanese large data set. Methods: This research was analyzed by using a clinical database of 11,228 Japanese breast cancer patients who registerd to cohort study as SN biopsy between March 2008 and Octover 2009 in Japan. We reviewed data retrospectively to extract patients with SN metastases who underwent complementary axillary lymph node dissection. In this cohort, we examined predictive factors of non-SN metastases. All clinical and pathologic features were analyzed to predict the non-SN status, by using univariate and multivariate logistic regression model. A receiver operating characteristic curve was constructed and the area under the curve (AUC) was calculated. Results: Among the database, SN metastases were found in 1,029 patients, and 345 (33.5%) were non-SN positive. Univariate analysis showed a significant association between non-SN involvement and primary tumor size (p<0.001), histologic grade (p=0.011), lymphatic invasion (p<0.001), venous invasion (p=0.005) and the number of involved SNs among all identified SNs (p<0.001). Tumor size (p<0.001), lymphatic invasion (p<0.001), and the size of SN metastasis (p<0.001) were associated with non-SN metastasis in multivariate analysis. Based on the multivariate analysis, we developed a scoring system to predict the likelihood of non-SN metastases in breast cancer patients with SN involvement. The discriminatory ability of our nomogram, as measured by the AUC, was 0.752. Conclusions: In patients with invasive breast cancer and a positive SN, primary tumor size, lymphatic invasion, and the size of SN metastases among all identified SNs were independently predictive of non-SN involvement, and used for a nomogram. Validation study will be performed in the future investigation.

Role of primary tumor resection in patients with metastatic medullary thyroid cancer who have unresectable distant metastases

Head & Neck ◽  
2021 ◽  
Vol 43 (11) ◽  
pp. 3386-3392
Author(s):  
Shi‐Min Zhuang ◽  
Liang‐En Xie ◽  
Feng Pang ◽  
Qian‐Yi Zhong ◽  
Xiao‐Mei Sun ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Primary Tumor ◽  
Medullary Thyroid Cancer ◽  
Tumor Resection ◽  
Distant Metastases ◽  
Primary Tumor Resection ◽  
Medullary Thyroid

scholarly journals Comparison of ultrasonography and CT for preoperative nodal assessment of patients with papillary thyroid cancer: diagnostic performance according to primary tumor size

2019 ◽  
Vol 61 (1) ◽  
pp. 21-27 ◽  
Author(s):  
So Yeon Yang ◽  
Jung Hee Shin ◽  
Soo Yeon Hahn ◽  
Yaeji Lim ◽  
Seok Young Hwang ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Tumor Size ◽  
Primary Tumor ◽  
Preoperative Evaluation ◽  
Papillary Thyroid ◽  
Primary Tumor Size ◽  
Tertiary Referral Center ◽  
Lower Accuracy ◽  
Sensitivity Specificity

Background Indications for computed tomography (CT) in preoperative patients with thyroid cancer are still controversial. Purpose To determine the value of CT and ultrasonography (US) in preoperative lymph node assessment of patients with papillary thyroid carcinoma (PTC) according to primary tumor size. Material and Methods A total 453 patients with surgically proven PTC who underwent US and CT for preoperative evaluation in 2010 at our tertiary referral center were included. The diagnostic sensitivity, specificity, and accuracy of US, CT, and the combination of US and CT (US/CT) in the preoperative nodal assessment were compared. We performed subgroup analysis to compare the findings according to primary tumor size. Results In overall tumors, adding CT to US had greater sensitivity, lower specificity, and greater accuracy in predicting central lymph node metastasis (LNM) but lower accuracy in prediction of lateral LNM. In smaller cancers (≤1 cm), US alone had greater specificity and accuracy than CT alone or US/CT in predicting lateral LNM. In larger cancers (>1 cm), CT had greater sensitivity and accuracy than US in predicting central LNM, while US had greater specificity and accuracy than CT in predicting lateral LNM. There were no patients with smaller tumors who showed retropharyngeal and superior mediastinal LNM diagnosed by CT alone. Conclusion CT is superior to US for detecting central LNM in preoperative patients with PTCs > 1 cm. However, there are no benefits to adding CT to US to predict lateral LNM in small cancers (≤1 cm).

Identification of a subgroup of patients with breast cancer and histologically positive axillary nodes receiving adjuvant chemotherapy who may benefit from postoperative radiotherapy.

1988 ◽  
Vol 6 (7) ◽  
pp. 1107-1117 ◽  
Author(s):  
B Fowble ◽  
R Gray ◽  
K Gilchrist ◽  
R L Goodman ◽  
S Taylor ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Tumor Size ◽  
Primary Tumor ◽  
Postoperative Radiotherapy ◽  
Eastern Cooperative Oncology Group ◽  
Distant Metastases ◽  
Primary Tumor Size ◽  
Axillary Nodes ◽  
Postmastectomy Radiation

Risk factors for isolated local-regional (LR) recurrence following mastectomy for breast cancer were analyzed in a review of 627 women entered into Eastern Cooperative Oncology Group (ECOG) adjuvant chemotherapy trials between 1978 and 1982. Premenopausal patients were randomized to cyclophosphamide, methotrexate, and fluorouracil (5-FU) (CMF), cyclophosphamide, methotrexate, 5-FU, and prednisone (CMFP), or cyclophosphamide, methotrexate, 5-FU, prednisone, and tamoxifen (CMFPT). Postmenopausal patients were randomized to observation, CMFP, or CMFPT. Median follow-up time was 4.5 years. At 3 years, 225 patients relapsed and in 70 (31% of failures, 11% of all patients) the initial site was LR without distant metastases. In a multivariate analysis, the risk of an isolated LR recurrence significantly correlated with the number of positive axillary nodes, the primary tumor size, the presence of tumor necrosis, and the number of axillary nodes examined. Factors that significantly discriminated between an isolated LR recurrence and distant metastasis were the number of positive nodes and primary tumor size. Patients with four to seven positive nodes or tumor size greater than or equal to 5 cm had a chance of developing an isolated LR recurrence almost equal to the risk of distant metastases. These findings suggest a potential for improved survival in this subset of patients with the addition of postmastectomy radiation to chemotherapy, and continue to emphasize the presence of a group of patients at high risk for isolated LR recurrence despite adjuvant chemotherapy.

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