Macroscopic lymph-node involvement and neck dissection predict lymph-node recurrence in papillary thyroid carcinoma.

ObjectiveWhether lymph-node dissection (LND) influences the lymph-node recurrence (LNR) risk in patients with papillary thyroid cancer remains controversial. The prognostic impact of macroscopic and microscopic lymph-node involvement at diagnosis is also an unresolved issue. A retrospective study was conducted to assess the influence of various LND procedures and to search for LNR risk factors.MethodsOverall 545 patients without distant metastases prior to surgery and main tumour ≥10 mm were included. A total thyroidectomy was performed in all patients with either no LND (Group 1,n=161), bilateral LND of the central and lateral compartments (Group 2,n=181) or all other dissection modalities (Group 3,n=203). Post-operative radioiodine was given to 496 (91%) patients. The 10-year cumulative probability of LNR was assessed and a prognostic study using multivariate analysis was performed.ResultsMacroscopic lymph-node metastases were present in 118 patients, 57 diagnosed before surgery and 61 only at surgery (including 81% in the central compartment). Overall, the 10-year cumulative probability of LNR was 7%. Macroscopic lymph-node metastases (P=0.001), extra-thyroidal invasion (P=0.017) and male gender (P=0.05) were independent risk factors, while bilateral LND of the central and lateral compartments was protective (P=0.028). In patients with macroscopic lymph-node metastases, the 10-year probability was lower in Group 2 than in Group 3 (10% vs 30%,P<0.01). In patients without macroscopic lymph-node metastases (n=427), no significant differences were observed between the three LND groups.ConclusionsPatients with macroscopic, but not microscopic, lymph-node involvement have a major LNR risk and need an optimal LND at primary surgery.

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Ultrasonography for the Prediction of High-Volume Lymph Node Metastases in Papillary Thyroid Carcinoma: Should Surgeons Believe Ultrasound Results?

World Journal of Surgery ◽

10.1007/s00268-020-05755-0 ◽

2020 ◽

Vol 44 (12) ◽

pp. 4142-4148

Author(s):

Chunhao Liu ◽

Lei Zhang ◽

Yuewu Liu ◽

Yu Xia ◽

Yue Cao ◽

...

Keyword(s):

Risk Factors ◽

Lymph Node ◽

Predictive Value ◽

High Volume ◽

Lymph Node Involvement ◽

Tumor Diameter ◽

Papillary Thyroid ◽

Node Involvement ◽

Node Metastases ◽

Male Sex

Abstract Background Lymph node metastasis (LNM) often occurs in papillary thyroid carcinoma (PTC); the efficacy of ultrasound for predicting high-volume lymph node metastases (LNMs) in patients with PTC remains unexplored. Methods The medical records of 2073 consecutive PTC patients were reviewed. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated to evaluate the efficacy of ultrasound. Risk factors for LNM/high-volume LNMs and lymph node involvement on ultrasound (usLNM) were identified by univariate and multivariate analyses. Results Of all the patients, 936 (45.2%) patients had LNMs, and 254 (12.3%) patients had high-volume LNMs. The sensitivity of ultrasound for detecting LNM/high-volume LNMs was 27.9% and 63.8%, respectively; the specificity was 93.1% and 90.3%, respectively. The NPV for ultrasound in detecting high-volume LNMs was 94.7%. In multivariate analysis, male sex (OR = 2.108, p < 0.001), tumor diameter > 1.0 cm (OR = 2.304, p < 0.001) and usLNM (+) (OR = 12.553, p < 0.001) were independent clinical risk factors for high-volume LNMs. Tumor diameter > 1 cm (OR = 3.036, p < 0.001) and male sex (OR = 1.642, p < 0.001) were independent clinical risk factors for usLNM; a skilled sonographer (OR = 1.121, p = 0.358) was not significantly associated with usLNM. Conclusions Lymph node involvement found by ultrasound has great predictive value for high-volume LNMs; the NPV is very high for patients without lymph node involvement on ultrasound. The ultrasound results do not appear to be influenced by the experience of the sonographer.

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Pattern of and clinicopathologic risk factors for lateral lymph node metastases in papillary thyroid carcinoma patients with lateral cervical lymphadenopathy

Medicine ◽

10.1097/md.0000000000012263 ◽

2018 ◽

Vol 97 (36) ◽

pp. e12263 ◽

Cited By ~ 10

Author(s):

Yanping Gong ◽

Jing Yang ◽

Shuping Yan ◽

Anping Su ◽

Feng liu ◽

...

Keyword(s):

Risk Factors ◽

Lymph Node ◽

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Lymph Node Metastases ◽

Cervical Lymphadenopathy ◽

Papillary Thyroid ◽

Lateral Lymph Node ◽

Node Metastases

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The Surgical Management of Papillary Thyroid Microcarcinoma: A 162-Month Single-Center Experience of 273 Cases

The American Surgeon ◽

10.1177/000313481207801127 ◽

2012 ◽

Vol 78 (11) ◽

pp. 1215-1218 ◽

Cited By ~ 5

Author(s):

Qingqing He ◽

Dayong Zhuang ◽

Luming Zheng ◽

Ziyi Fan ◽

Peng Zhou ◽

...

Keyword(s):

Risk Factors ◽

Lymph Node ◽

Surgical Management ◽

Lymph Node Metastases ◽

Papillary Thyroid Microcarcinoma ◽

Papillary Thyroid ◽

Neck Lymph Node ◽

Lateral Node ◽

Thyroid Microcarcinoma ◽

Node Metastases

The aim of this study was to evaluate outcomes for patients with papillary thyroid microcarcinoma (PTMC) treated at a single institution during a 162-month period and to determine which patients need aggressive treatment. Two hundred seventy-three patients with PTMC had subtotal or total thyroidectomy 1 prophylactic or therapeutic lymph node dissection. Clinical and histopathological characteristics of 273 patients were identified and statistically analyzed. The tumors were multifocal in 36.3 per cent of the patients with PTMCs. Fifty-six per cent had neck lymph node metastases at diagnosis. Large-sized tumor (over 5 mm), age older than 45 years, multifocality, bilaterality, and extrathyroidal extension were associated with subclinical central lymph node metastases. Ninety-six patients older than 45 years of age were upgraded from Stage I to III or IVA. Ten patients with lateral node recurrence or local recurrence in the residual thyroid had one or more risk factors. The high rates of multifocality and Level VI area subclinical lymph node metastasis were two important clinical and histopathological characteristics of PTMC. Patients who had one or more risk factors should receive more aggressive surgical management.

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Primary and secondary cutaneous CD30+lymphoproliferative disorders: a report from the Dutch Cutaneous Lymphoma Group on the long-term follow-up data of 219 patients and guidelines for diagnosis and treatment

Blood ◽

10.1182/blood.v95.12.3653 ◽

2000 ◽

Vol 95 (12) ◽

pp. 3653-3661 ◽

Cited By ~ 477

Author(s):

Marcel W. Bekkenk ◽

Françoise A. M. J. Geelen ◽

Pieter C. van Voorst Vader ◽

F. Heule ◽

Marie-Louise Geerts ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Involvement ◽

Lymphoproliferative Disorders ◽

Group 4 ◽

Long Term Follow Up ◽

Node Involvement ◽

Group 3 ◽

Group 2 ◽

Multiagent Chemotherapy ◽

Group 1

Abstract To evaluate our diagnostic and therapeutic guidelines, clinical and long-term follow-up data of 219 patients with primary or secondary cutaneous CD30+ lymphoproliferative disorders were evaluated. The study group included 118 patients with lymphomatoid papulosis (LyP; group 1), 79 patients with primary cutaneous CD30+ large T-cell lymphoma (LTCL; group 2), 11 patients with CD30+ LTCL and skin and regional lymph node involvement (group 3), and 11 patients with secondary cutaneous CD30+ LTCL (group 4). Patients with LyP often did not receive any specific treatment, whereas most patients with primary cutaneous CD30+ LTCL were treated with radiotherapy or excision. All patients with skin-limited disease from groups 1 and 2 who were treated with multiagent chemotherapy had 1 or more skin relapses. The calculated risk for systemic disease within 10 years of diagnosis was 4% for group 1, 16% for group 2, and 20% for group 3 (after initial therapy). Disease-related 5-year-survival rates were 100% (group 1), 96% (group 2), 91% (group 3), and 24% (group 4), respectively. The results confirm the favorable prognoses of these primary cutaneous CD30+ lymphoproliferative disorders and underscore that LyP and primary cutaneous CD30+ lymphomas are closely related conditions. They also indicate that CD30+ LTCL on the skin and in 1 draining lymph node station has a good prognosis similar to that for primary cutaneous CD30+ LTCL without concurrent lymph node involvement. Multiagent chemotherapy is only indicated for patients with full-blown or developing extracutaneous disease; it is never or rarely indicated for patients with skin-limited CD30+ lymphomas.

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Primary and secondary cutaneous CD30+lymphoproliferative disorders: a report from the Dutch Cutaneous Lymphoma Group on the long-term follow-up data of 219 patients and guidelines for diagnosis and treatment

Blood ◽

10.1182/blood.v95.12.3653.012k23_3653_3661 ◽

2000 ◽

Vol 95 (12) ◽

pp. 3653-3661 ◽

Cited By ~ 41

Author(s):

Marcel W. Bekkenk ◽

Françoise A. M. J. Geelen ◽

Pieter C. van Voorst Vader ◽

F. Heule ◽

Marie-Louise Geerts ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Involvement ◽

Lymphoproliferative Disorders ◽

Group 4 ◽

Long Term Follow Up ◽

Node Involvement ◽

Group 3 ◽

Group 2 ◽

Multiagent Chemotherapy ◽

Group 1

To evaluate our diagnostic and therapeutic guidelines, clinical and long-term follow-up data of 219 patients with primary or secondary cutaneous CD30+ lymphoproliferative disorders were evaluated. The study group included 118 patients with lymphomatoid papulosis (LyP; group 1), 79 patients with primary cutaneous CD30+ large T-cell lymphoma (LTCL; group 2), 11 patients with CD30+ LTCL and skin and regional lymph node involvement (group 3), and 11 patients with secondary cutaneous CD30+ LTCL (group 4). Patients with LyP often did not receive any specific treatment, whereas most patients with primary cutaneous CD30+ LTCL were treated with radiotherapy or excision. All patients with skin-limited disease from groups 1 and 2 who were treated with multiagent chemotherapy had 1 or more skin relapses. The calculated risk for systemic disease within 10 years of diagnosis was 4% for group 1, 16% for group 2, and 20% for group 3 (after initial therapy). Disease-related 5-year-survival rates were 100% (group 1), 96% (group 2), 91% (group 3), and 24% (group 4), respectively. The results confirm the favorable prognoses of these primary cutaneous CD30+ lymphoproliferative disorders and underscore that LyP and primary cutaneous CD30+ lymphomas are closely related conditions. They also indicate that CD30+ LTCL on the skin and in 1 draining lymph node station has a good prognosis similar to that for primary cutaneous CD30+ LTCL without concurrent lymph node involvement. Multiagent chemotherapy is only indicated for patients with full-blown or developing extracutaneous disease; it is never or rarely indicated for patients with skin-limited CD30+ lymphomas.

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Postoperative chemoradiotherapy in patients with rectal cancer, prognostic factors for disease control and survival

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.13575 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 13575-13575 ◽

Cited By ~ 2

Author(s):

M. Hetnal ◽

K. Malecki ◽

S. Korzeniowski ◽

T. Zemelka

Keyword(s):

Rectal Cancer ◽

Prognostic Factors ◽

Lymph Node ◽

Lymph Nodes ◽

Lymph Node Metastases ◽

Lymph Node Involvement ◽

Fatty Tissue ◽

Free Survival ◽

Node Involvement ◽

Node Metastases

13575 Background: The aim of this paper is an assessment of results of adjuvant chemoradiotherapy in patients with rectal cancer with respect to prognostic factors, causes of treatment failures and treatment tolerance. Methods: 178 pts with Dukes’ stage B or C rectal cancer received postoperative chemoradiotherapy between 1993 and 2002. Median age was 62; 110 patients were males, 68 were females. Median follow-up time was 45 months. Main endpoints of the analysis were locoregional recurrence-free survival (LRRFS), distant relapse free survival (DRFS), disease free survival (DFS) and overall survival (OS). Kaplan-Meier method was used to calculate survival rates. Univariate and multivariate analyses of prognostic factors were performed using log rank and Cox’s proportional hazard method. Results: The 5-year LRRFS was 73%, DRFS was 80%, DFS was 61% and OS was 65%. Lymph node involvement and method of resection (AR favoured) were the only independent prognostic factors for LRRFS. Lymph node involvement, in particular when four or more are involved, was independent prognostic factors for DFS. For DRFS are histological grade, lymph node involvement and extracapsular extension of the lymph node metastases. For OS, the independent prognostic factors were infiltration of the pararectal fatty tissue, lymph node involvement in particular when four or more are involved, total number of chemotherapy cycles (at least six favoured). The 5-year LRRFS was 73%, DRFS was 80%, DFS was 61% and OS was 65%. Radiation therapy was well tolerated in 45% of patients. Most common early reactions were diarrhoea, nausea/vomiting and leucopoenia. Conclusions: Involvement of lymph nodes and method of resection were the only independent prognostic factors for LRRFS. Prognostic factors for OS were infiltration of the pararectal fatty tissue, lymph node metastases, four or more involved lymph nodes, total number of chemotherapy cycles. No significant financial relationships to disclose.

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The value of tumor marker and cytokine analysis for the assessment of regional lymph node status in cervical cancer patients

International Journal of Gynecological Cancer ◽

10.1111/j.1525-1438.2007.01176.x ◽

2008 ◽

Vol 18 (6) ◽

pp. 1279-1284 ◽

Cited By ~ 11

Author(s):

B. Kotowicz ◽

M. Fuksiewicz ◽

M. Kowalska ◽

J. Jonska-Gmyrek ◽

M. Bidzinski ◽

...

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Lymph Node Metastases ◽

Regional Lymph Node ◽

Serum Levels ◽

Lymph Node Involvement ◽

Lymph Node Status ◽

Node Status ◽

Node Involvement ◽

Node Metastases

The aim of the study was to evaluate the utility of the measurements of the circulating tumor markers, squamous cell carcinoma antigen (SCCA), CA125, carcinoembryonic antigen (CEA), cytokeratin fragment 19 (CYFRA 21.1), and the cytokines, interleukin-6 and vascular endothelial growth factor (VEGF), to estimate regional lymph node involvement in patients with cervical cancer. The study comprised 182 untreated patients with cervical cancer. The regional lymph node status was assessed either by the postsurgical histopathologic examination or by the computed tomography (CT). Concentrations of SCCA, CEA, and CA125 were determined using the Abbott Instruments system, of CYFRA 21.1 by the Roche kits, and of IL-6 and VEGF by the ELISA of R&D Systems (Minneapolis, MN). For the statistical analyses, Mann–Whitney U test and χ2 test were applied. Serum levels of SCCA, CEA, CA125, CYFRA 21.1, IL-6, and VEGF were measured in patients with specified pelvic and para-aortic lymph node status. SCCA, CA125, and IL-6 levels were found to be significantly higher in patients with lymph node metastases than in those with no lymph node involvement. Also, the percentage of patients with simultaneously elevated concentrations of SCCA and CA125 or SCCA and IL-6 differed depending on the lymph node status and was significantly higher in the series of patients with lymph node metastases. Simultaneous assessment of serum levels of SCCA and CA125 or SCCA and IL-6 in patients with cervical cancer may be useful for the regional lymph node evaluation, especially in patients with advanced stages, when the lymph nodes are examined only by CT, with no histologic confirmation.

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RISK FACTORS FOR CENTRAL LYMPH NODE METASTASES IN PATIENTS WITH PAPILLARY THYROID MICROCARCINOMA

Endocrine Practice ◽

10.4158/ep-2018-0305 ◽

2018 ◽

Vol 24 (12) ◽

pp. 1057-1062 ◽

Cited By ~ 8

Author(s):

Xin Wu ◽

Binglu Li ◽

Chaoji Zheng ◽

Xiaodong He

Keyword(s):

Risk Factors ◽

Lymph Node ◽

Lymph Node Metastases ◽

Papillary Thyroid Microcarcinoma ◽

Papillary Thyroid ◽

Central Lymph Node ◽

Thyroid Microcarcinoma ◽

Node Metastases ◽

Central Lymph

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Surgical staging for epithelial ovarian tumors of low malignant potential

International Journal of Gynecological Cancer ◽

10.1046/j.1525-1438.1994.04050310.x ◽

1994 ◽

Vol 4 (5) ◽

pp. 310-314 ◽

Cited By ~ 14

Author(s):

F. Di Re ◽

R. Fontanelli ◽

F. Raspagliesi ◽

D. Paladini ◽

E. A.A. Feudale

Keyword(s):

Lymph Node ◽

Lymph Node Involvement ◽

Pelvic Lymphadenectomy ◽

Malignant Potential ◽

Ovarian Tumors ◽

Low Malignant Potential ◽

Node Involvement ◽

Node Metastases ◽

Group 2 ◽

Group 1

From January 1975 to December 1991, 34 patients with a diagnosis of epithelial ovarian tumors of low malignant potential (LMP) were admitted to the Istituto Nazionale Tumori of Milan. Eighteen of them (group 1) underwent complete staging laparotomy and retroperitoneal para-aortic and pelvic lymphadenectomy, as for ovarian cancer. In the remaining 16 cases (group 2), the surgical treatment ranged from unilateral oophorectomy to incomplete staging procedure. In group 1, nine patients (50%) were found to have retroperitoneal nodal involvement. In group 2, all patients had stage I disease. Patients were followed up for 20–222 months (mean 108, median 86). There were two recurrences in group 2 (after 5 years) and none in group 1 (NS). Currently all patients are alive and disease free. Nine of 18 group 1 patients were upstaged to stage III on the basis of lymph node involvement only. However, at least in this retrospective series, lymph node metastases did not affect prognosis or survival.

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