Prediction mode of more than 5 central lymph nodes metastases in clinically node-negative ipsilateral papillary thyroid carcinoma with tumor size 1 to 4 cm

ObjectiveThe lymph node posterior to the right recurrent laryngeal nerve (LN-prRLN) is an important part of the central lymph nodes (LNs). We aimed to explore the rate and predictors of LN-prRLN metastasis in cN0 papillary thyroid carcinoma (PTC) located at the left thyroid lobe.MethodsPatients with surgically treated primary left lobe PTC were retrospectively enrolled. The metastatic distribution of LN-prRLN and postoperative complications were assessed. The association between LN-prRLN metastasis and clinicopathological variables was evaluated by univariate and multivariate analyses.ResultsA total of 857 patients were included for the analysis. Central LN metastasis was noted in 310 (35.3%) cases. The most (27.6%) and least (1.7%) commonly involved LNs were the left paratracheal LN and the LN-prRLN. In the univariate analysis, the tumor size, multifocality, the extent of extrathyroidal extension (none vs. macroscopic vs. macroscopic maximal), and perineural invasion were associated with positive LN-prRLN. In the multivariate analysis, tumor size of >40.0 mm and macroscopic maximal invasion were found as the only two independent predictors. Transient and permanent hypoparathyroidism were noted in 90 (10.2%) and 13 (1.5%) patients, respectively. Voice change was noted in 40 (4.6%) patients, and 20 patients recovered.ConclusionsIn cN0 PTC located at the left lobe, LN-prRLN metastasis was very uncommon. We found that LN-prRLN dissection is not required routinely, but should be performed if the tumor size is >40.0 mm and macroscopic maximal extrathyroidal extension is present.

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Carbon nanoparticle-guided central lymph node dissection in clinically node-negative patients with papillary thyroid carcinoma

Head & Neck ◽

10.1002/hed.24060 ◽

2015 ◽

Vol 38 (6) ◽

pp. 840-845 ◽

Cited By ~ 19

Author(s):

Youzhi Zhu ◽

Xiangjin Chen ◽

Huihao Zhang ◽

Ling Chen ◽

Shujun Zhou ◽

...

Keyword(s):

Lymph Node ◽

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Papillary Thyroid ◽

Node Dissection ◽

Central Lymph Node ◽

Carbon Nanoparticle ◽

Node Negative ◽

Central Lymph Node Dissection ◽

Central Lymph

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Incidence and Clinical Significance of Delphian Lymph Node Metastasis in Unilateral Papillary Thyroid Carcinoma

10.21203/rs.3.rs-33260/v1 ◽

2020 ◽

Author(s):

Wei Liu ◽

Zhenglin Wang ◽

Cong Wang ◽

Zhilong Ai

Keyword(s):

Lymph Node ◽

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Lymph Nodes ◽

Clinical Significance ◽

Tumor Size ◽

Frozen Section ◽

Extrathyroidal Extension ◽

Capsular Invasion ◽

Papillary Thyroid

Abstract Background: Some studies have reported that Delphian lymph node (DLN) metastasis is associated with a poor prognosis of papillary thyroid carcinoma (PTC), but the number of the available studies is limited and the results are inconsistent. The aim of this investigation was to study the incidence and clinical significance of DLN metastasis in patients with unilateral PTC.Methods: This was a cross-sectional study from January 2016 to December 2019. The data were obtained from the department of general surgery in Shanghai Zhongshan Hospital affiliated to Fudan University. This study included 522 patients with unilateral PTC and had DLN harvested. The associations between DLN metastasis and the clinical characteristics of the patients, i.e. age, sex, tumor size, multifocality, capsular invasion, extrathyroidal extension, central lymph nodes (CLN) metastasis (excluding DLN), and lateral lymph nodes (LLN) metastasis was analyzed.Results: Among all the 522 patients, 133 (25.5%) patients had metastasized DLN lymph nodes. DLN metastasis was significantly associated with age (p = 0.047), male (p < 0.001), larger tumor size (p < 0.001), capsular invasion (p < 0.001), extrathyroidal extension (p = 0.004), tumor location in upper third (p = 0.003), other CLN metastasis (p < 0.001), number of positive CLN (excluding DLN) (p < 0.001), LLN metastasis (p = 0.036), number of positive LLN (p = 0.004) and number of DLN removed (p = 0.043). No association was found between DLN metastasis and multifocality, number of CLN removed and number of LLN removed.Conclusions: DLN metastasis is associated with some adverse prognostic markers of PTC. If the DLN is positive on intraoperative frozen section, careful dissection of CLN and careful evaluation of LLN are essential, and intensive follow-up should be warranted.

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Impact of Prophylactic Bilateral Central Lymph Nodes Dissection in Patients with Papillary Thyroid Carcinoma; Short Term Outcome

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2020/v32i1630625 ◽

2020 ◽

pp. 18-25

Author(s):

Mohammed Farid Elhelbawy ◽

Ahmed Elgendy ◽

Ahmed Attia Darwish ◽

Abd El-Wahhab Hemedah Gad

Keyword(s):

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Lymph Nodes ◽

Recurrent Laryngeal Nerve ◽

Nerve Injury ◽

Recurrent Laryngeal Nerve Injury ◽

Laryngeal Nerve ◽

Papillary Thyroid ◽

Laryngeal Nerve Injury ◽

Central Lymph

Background: Papillary thyroid carcinoma is the most common thyroid carcinoma. There is a debate on prophylactic removal of central lymph nodes. Some authors advise it to avoid recurrence while other investigators condemn it due to its higher risk of recurrent laryngeal nerve injury and/or hypoparathyroidism. Aim of the Work: The aim of this study was to evaluate the safety and morbidity of central lymph nodes dissection during total thyroidectomy in the management of patients with papillary thyroid carcinoma. Patients and Methods: Twelve patients were confirmed by histopathological evaluation to have papillary thyroid examination. Total thyroidectomy was done through transverse neck incision followed by removal of bilateral central group of lymph nodes. Patients were examined postoperatively for recurrent laryngeal nerve injury or hypoparathyroidism. Follow up was done 6 months later with neck ultrasonography, thyroglobulin and antithyroglobulin antibodies. Results: Thirty four percent of the studied cases proved to have lymph nodes metastasis. temporary hypocalcemia occurred in only one patient in this study and was temporary. Recurrent laryngeal nerve affection happened in 17% of the studied cases and was reversible by medical treatment. No evidence of recurrence happened in the first 6 months after operation. Conclusion: The risk of postoperative recurrent laryngeal nerve injury or hypoparathyroidism is minimal after prophylactic CLND. Postoperative hypocalcemia and recurrent laryngeal nerve injury are usually reversible.

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The Clinical and Prognosis Value of the Number of Metastatic Lymph Nodes in Papillary Thyroid Carcinoma Patients

10.21203/rs.3.rs-96102/v1 ◽

2020 ◽

Author(s):

Ling Zhan ◽

Hong-fang Feng ◽

Xi-zi Yu ◽

Ling-rui Li ◽

Jun-long Song ◽

...

Keyword(s):

Lymph Node ◽

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Lymph Nodes ◽

Tumor Size ◽

Tumor Diameter ◽

Papillary Thyroid ◽

Metastatic Lymph Nodes ◽

Metastatic Lymph ◽

High Prevalence

Abstract Objective: It has been reported that papillary thyroid carcinoma (PTC) patients with lymph node metastasis (LNM) are more associated with adverse outcomes. This study aimed to assess the correlation between the lymph node (LN) status and clinical prognosis in PTC patients. Methods: We retrospectively reviewed the medical records of PTC patients who underwent initial thyroid cancer surgery in Renmin Hospital of Wuhan University between 2017 and 2019. 1021 PTC patients with total checked number of lymph nodes ≥5 were involved in this study. The clinicopathological characteristics of patients were compared according to the LN status and the number of metastatic lymph nodes (NMLNs). Results: The LNM and NMLNs>5 were seen in 694 (68.0%) and 222 (21.7%) cases, respectively. Young patients, patients with larger tumor diameter, bilaterality, multifocality and gross extrathyroidal extension (ETE) were more inclined to LNM and NMLNs >5 (P<0.001). The patients with LNM (pN1) were mainly among males and were exhibited multifocality and advanced tumor stage (P<0.001), while pN1 patients with NMLNs >5 were negatively associated with advanced tumour stage (P<0.05). Recurrence-free survival among pN1 patients was significantly different between 2 groups (NMLNs ≤5: 0/472, 100.0%; NMLNs >5: 5/222, 97.7%; P=0.002). In multivariate logistic regression analysis, the male (OR=2.580, P<0.001), 10-mm tumor size (OR=1.770, P<0.001), tumor gross ETE (OR=2.004, P<0.001) were independent predictors for the high prevalence of LNM. Similarly, 10-mm tumor size (OR=1.399, P<0.05), bilaterality (OR=2.350, P<0.001) and tumor gross ETE (OR=2.660, P<0.05) were also independent predictors for the high prevalence of NMLNs >5; 10-year age was an independent predictor for the low prevalence of the LNM (OR=0.658, P<0.001) and NMLNs >5 (OR=0.678, P<0.001). Conclusions: The status of the cervical LNs and the NMLNs should be correctly evaluated to guide reasonable treatment and careful follow-up.

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Papillary Thyroid Carcinoma: Analysis of the Central Compartmentʼs Lymph Nodes Metastases

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2017.49 ◽

2017 ◽

Vol 60 (1) ◽

pp. 44-50 ◽

Cited By ~ 2

Author(s):

Ján Sojak ◽

Marian Sičák ◽

Adrian Kališ ◽

Michal Slašťan

Keyword(s):

Risk Factors ◽

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Lymph Nodes ◽

Primary Tumour ◽

Papillary Thyroid ◽

Aggressive Disease ◽

Regional Metastases ◽

Metastatic Involvement ◽

Lymph Nodes Metastases

Background: Papillary thyroid carcinoma is typical by regional lymph nodes metastases. Therefore we decided to analyse associated risk factors. Objective: In this retrospective study we focused on the incidence of metastatic involvement of the central compartment’s lymph nodes correlated with age, size of the primary tumour, infiltration of thyroid gland capsule, positive lymphangioinvasion in order to assess risk factors. Method: We analysed group of 156 patients with papillary carcinoma, who have undergone total thyroidectomy and bilateral elective central compartment neck dissection. We evaluated the occurrence of metastases, size, infiltration and lymphangioinvasion based on definitive histology of the whole group and separately for subgroups of patients under and over 45 years. Result: We found metastatic involvement in 88 (56.4%) patients. When comparing the subgroups of patients under (73 patients) and over 45 years (83 patients), we found metastases in 56 vs. 32 (76.7% vs. 38.6%) patients. In the subgroup of younger patients we found significant higher incidence of metastases compared with the group of over 45 years, P < 0.001 (P = 0.000027). We found significant higher incidence of metastases in patients with positive capsule infiltration in the whole group, P < 0.001 (P = 0.00049); in the subgroup of under 45 years, P < 0.001 (P = 0.00091) and in patients with positive lymphangioinvasion in the whole group, P < 0.01 (P = 0.00177); in the subgroup of over 45 years, P < 0.001 (P = 0.0002). In patients with metastases we found tumour size ≥1cm more frequently in all groups. Conclusion: We recorded higher incidence of regional metastases in patients under 45 years, positive capsule infiltration, lymphangioinvasion. Age under 45 years itself does not correlate with less aggressive disease, to the contrary some of other analysed risk factors correlate with more aggressive disease.

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