Lymph node metastases location (central vs lateral neck) in well-differentiated thyroid carcinoma: Is it important?

Abstract Introduction: Thyroglobulin evaluation in the washout of fine-needle aspiration (FNA-Tg) is an accurate diagnostic method of lymph node metastases (LNM) of differentiated thyroid carcinoma (DTC). Serum anti-thyroglobulin antibodies (AATg) may cause falsely low serum Tg values, but their effect on FNA-Tg has not been well established. There are also concerns about the possibility that suppressed TSH results in false-negative FNA-Tg. Our objectives were to evaluate the effect of serum AATg and TSH level on FNA-Tg of LNM of DTC and to determine the presence of AATg on the washout of fine needle aspiration (FNA-AATg). Methods: Retrospective analysis of patients who underwent FNA-Tg assay in LNM of DTC. The sample was divided in two groups according to the presence of serum AATg at the time of FNA-Tg evaluation (Group 1: positive AATg, n =47; Group 2: negative AATg, n =50). Results: There was no significant difference in the FNA-Tg between the two groups ( p =0.066), although it was lower in Group 1 (1428 ng/mL) than in Group 2 (14842 ng/mL). FNA-Tg was able to identify 10.3% LNM of DTC that would not be diagnosed based solely on cytology. FNA-AATg evaluation was positive in 12.8% of the Group 1 patients and did not seem to interfere with FNA-Tg value ( p =0.732). There were no differences in the median FNA-Tg measurements between those on levothyroxine suppressive therapy and those on substitutive therapy ( p =0.800). Conclusion: FNA-Tg assay appears to be a good diagnostic tool even in patients with positive serum AATg and those under suppressive levothyroxine therapy.

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Risk Factors for Lateral Lymph Node Metastases in Patients With Sporadic Medullary Thyroid Carcinoma

Technology in Cancer Research & Treatment ◽

10.1177/1533033820962089 ◽

2020 ◽

Vol 19 ◽

pp. 153303382096208

Author(s):

Xin Wu ◽

Binglu Li ◽

Chaoji Zheng ◽

Wei Liu ◽

Tao Hong ◽

...

Keyword(s):

Lymph Node ◽

Thyroid Carcinoma ◽

Medullary Thyroid Carcinoma ◽

Lymph Node Metastases ◽

Lateral Neck ◽

Lateral Neck Dissection ◽

Lateral Lymph Node ◽

Sporadic Medullary Thyroid Carcinoma ◽

Medullary Thyroid ◽

Node Metastases

Purpose: Medullary thyroid carcinoma is a rare endocrine malignancy; 75% of patients with this disease have sporadic medullary thyroid carcinoma. While surgery is the only curative treatment, the benefit of prophylactic lateral neck dissection is unclear. This study aimed to analyze the clinicopathological risk factors associated with lateral lymph node metastases and determine the indication for prophylactic lateral neck dissection in patients with sporadic medullary thyroid carcinoma. Methods: The medical records of patients with medullary thyroid carcinoma who were treated at our hospital between January 2002 and January 2020 were retrospectively reviewed; a database of their demographic characteristics, test results, and pathological information was constructed. The relationship between lateral lymph node metastases and clinicopathologic sporadic medullary thyroid carcinoma features were analyzed using univariate and multivariate analyses. Results: Overall, 125 patients with sporadic medullary thyroid carcinoma were included; 47.2% and 39.2% had confirmed central and lateral lymph node metastases, respectively. Univariate and multivariate analyses identified 2 independent factors associated with lateral lymph node metastases: positive central lymph node metastases (odds ratio = 9.764, 95% confidence interval: 2.610–36.523; p = 0.001) and positive lateral lymph nodes on ultrasonography (odds ratio = 101.747, 95% confidence interval: 14.666–705.869; p < 0.001). Conclusion: Medullary thyroid carcinoma is a rare endocrine malignancy. Lymph node metastases are common in patients with sporadic medullary thyroid carcinoma. Prophylactic lateral neck dissection is recommended for patients who exhibit positive central lymph node metastases and/or positive lateral lymph nodes on ultrasonography.

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Value of ultrasound in detecting central compartment lymph node metastases in differentiated thyroid carcinoma

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-013-2636-4 ◽

2013 ◽

Vol 271 (5) ◽

pp. 1215-1218 ◽

Cited By ~ 11

Author(s):

Aviram Mizrachi ◽

Raphael Feinmesser ◽

Gideon Bachar ◽

Ohad Hilly ◽

Maya Cohen

Keyword(s):

Lymph Node ◽

Thyroid Carcinoma ◽

Lymph Node Metastases ◽

Central Compartment ◽

Differentiated Thyroid Carcinoma ◽

Node Metastases

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Aberrant intrathyroidal lymph node metastasis in classical papillary thyroid carcinoma

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00614-x ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Wan Mohd Nazlee Wan Zainon ◽

Wan Faiziah Wan Abdul Rahman ◽

Maya Mazuwin Yahya ◽

Nor Azwani Mat Nawi ◽

Nurul Shamimi Suhaimi ◽

...

Keyword(s):

Lymph Node ◽

Papillary Thyroid Carcinoma ◽

Lymph Node Metastasis ◽

Thyroid Carcinoma ◽

Lymph Node Metastases ◽

Differentiated Thyroid Carcinoma ◽

High Dose ◽

Papillary Thyroid ◽

Node Metastasis ◽

Node Metastases

Abstract Background In cases of papillary thyroid carcinoma (PTC), lymph nodes are a typical site of metastasis. Extrathyroidal tissue involvement in differentiated thyroid carcinoma causes the disease to progress and affects the patients’ treatment options. Papillary thyroid carcinoma (PTC) is the common type in differentiated thyroid carcinoma (DTC), the other type is follicular thyroid carcinoma (FTC). Ectopic sites, such as intrathyroidal lymph node invasion in classical papillary thyroid malignancy, are extremely uncommon. It can be difficult to detect an intrathyroidal lymph node (ITLN) during a histopathological test, but it is important to do so since it affects the stage of the disease and subsequent treatment. Case presentation We present the case of a 63-year-old woman who presented with multinodular goitre and underwent total thyroidectomy. She was diagnosed with aberrant intrathyroidal lymph node metastases during pathological testing, resulting in an upgrade in treatment. Owing to the exceptionally unusual ectopic position of lymph node metastasis, in this case, there is a risk of diagnostic and therapeutic misinterpretation. This patient was treated with high-dose radioactive iodine in view of lymph node metastases. Conclusions Identification of ITLN by imaging characteristics is sometimes difficult, being often an intraoperative discovery and histopathological correlation that lead to upstage the disease and alter the final management.

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Rate of elimination of radioiodineavid lymph node metastases of differentiated thyroid carcinoma by postsurgical radioiodine ablation

Nuklearmedizin ◽

10.3413/nukmed-0794-16-01 ◽

2016 ◽

Vol 55 (06) ◽

pp. 221-227

Author(s):

Mona Mustafa ◽

Peter Bartenstein ◽

Torsten Kuwert ◽

Daniela Schmidt ◽

Harun Ilhan

Keyword(s):

Lymph Node ◽

Thyroid Carcinoma ◽

Lymph Node Metastases ◽

Treatment Success ◽

Spiral Ct ◽

Differentiated Thyroid Carcinoma ◽

Short Axis ◽

Radioiodine Ablation ◽

Node Metastases

SummarySPECT/CT detects radioiodine-positive cervical lymph node metastases (LNMs) of differentiated thyroid carcinoma (DTC) at the time of postsurgical radioablation (RA). Preliminary evidence indicates that the majority of LNMs are successfully treated by RA. The aim of this study was to confirm this evidence in a bicentric setting and to evaluate whether size is a predictor for successful elimination. Patients and methods: Since 01/2007 and 05/2008, respectively, SPECT/spiral-CT is performed routinely in all patients with DTC at RA in two University Clinics. The outcome of iodine-positive LNMs identified by SPECT/CT until 12/2012 was analyzed by follow-up diagnostic 131I scans and serum thyreoglobulin (Tg) values. LNM volume and short-axis diameter were evaluated as prognostic factors by a receiver-operating characteristic (ROC) analysis. Results: 79 patients with 97 iodine-positive LNMs were included. Surgery was carried out in 8 patients with 13 LNMs due to the presence of additional iodine-negative lesions. Of the remaining 84 LNMs, 74 (88%) were successfully treated as demonstrated by radioiodine scans at follow-up. 10 LNMs persisted. 67/70 LNMs smaller than 0.9 ml were treated successfully, whereas this was the case of only 6/14 exceeding this threshold. Using this cut-off level to predict treatment success, sensitivity, specificity, positive and negative predictive value were 92%, 73%, 96%, and 57%. Results for short-axis diameter (cut-off level < 1cm) were 90%, 69%, 94% and 56%. Conclusion: RA is effective in the treatment of the majority of 131I-positive LNMs identified in SPECT/CT images. In this study, 88% of iodine-positive LNM in DTC were successfully treated by radioiodine given at RA. Both LNM volume and diameter are reliable predictors of treatment success.

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The study of influence factors on 131I treatment of differentiated thyroid carcinoma with lymph node metastases

Clinical Imaging ◽

10.1016/j.clinimag.2008.09.006 ◽

2009 ◽

Vol 33 (3) ◽

pp. 221-225 ◽

Cited By ~ 2

Author(s):

Zhi-Yi Ye ◽

Hui Wang ◽

Hong-Liang Fu ◽

Jia-Ning Li ◽

Ren-Jian Zou ◽

...

Keyword(s):

Lymph Node ◽

Thyroid Carcinoma ◽

Lymph Node Metastases ◽

Influence Factors ◽

Differentiated Thyroid Carcinoma ◽

131I Treatment ◽

Node Metastases

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Prophylactic lymph node dissection in clinically N0 differentiated thyroid carcinoma: example of personalized treatment

Personalized Medicine ◽

10.2217/pme-2019-0119 ◽

2020 ◽

Vol 17 (4) ◽

pp. 317-338

Author(s):

Maria V Deligiorgi ◽

Mihalis I Panayiotidis ◽

Dimitrios T Trafalis

Keyword(s):

Lymph Node ◽

Thyroid Carcinoma ◽

Lymph Node Dissection ◽

Lymph Node Metastases ◽

Differentiated Thyroid Carcinoma ◽

Node Dissection ◽

Main Culprit ◽

Treatment Paradigm ◽

Node Metastases ◽

Prophylactic Lymph Node Dissection

Considering the ‘differentiated thyroid carcinoma (DTC) epidemic’, the indolent nature of DTC imposes a treatment paradigm shift toward elimination of recurrence. Lymph node metastases in cervical compartments, encountered in 20–90% of DTC, are the main culprit of recurrent disease, affecting 5–30% of patients. Personalized risk-stratified cervical prophylactic lymph node dissection (PLND) at initial thyroidectomy in DTC with no clinical, sonographic or intraoperative evidence of lymph node metastases (clinically N0) has been advocated, though not unanimously. The present review dissects the controversy over PLND. Weighing the benefit yielded from PLND up against the PLND-related morbidity is so far hampered by the inconsistent profit yielded by PLND and the challenging patient selection. Advances in tailoring PLND are anticipated to empower optimal patient care.

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