Laser Ablation Treatment of Recurrent Lymph Node Metastases from Papillary Thyroid Carcinoma

(1) Background: The incidence of papillary thyroid cancers is increasing. Papillary neoplasm metastasizes to the central and lateral lymph nodes of the neck. The recurrence rate is less than 30%. The gold standard of treatment for lymph node recurrences is surgery, but surgery is burdened by a high rate of complications. Therefore, laser ablation of recurrent lymph nodes has been recognized as an alternative treatment with minimal invasiveness, a low complication rate and a curative effect. (2) Methods: We analyzed 10 patients who underwent a total thyroidectomy and metabolic radiotherapy and who developed a lymph node recurrence in the laterocervical compartment in the following 12–18 months. (3) Results: Patients developed lymph node recurrence at IV and Vb levels in 70% and 30% of cases, respectively. All patients were treated with a single laser ablative session. Hydrodissection was performed in all patients. The energy delivered was 1120 ± 159.3 Joules and 3–4 Watts in 362 ± 45.7 s. No complications were reported. All patients underwent a 6-month follow-up. A volumetric reduction of 40.12 ± 2.2%, 49.1 ± 2.13% and 59.8 ± 3.05%, respectively at 1-, 3- and 6-months of follow-up was reported. (4) Conclusions: At 6 months, a fine needle aspiration was performed, which was negative for malignant cells and negative for a dosage of Thyroglobulin in eluate. The laser ablation is an effective alternative to surgical treatment.

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Percutaneous ultrasound-guided laser ablation for the treatment of cervical tuberculous lymphadenitis: a pilot study

Journal of International Medical Research ◽

10.1177/0300060518821818 ◽

2019 ◽

Vol 47 (4) ◽

pp. 1512-1520

Author(s):

Gaoyi Yang ◽

Jianhua Fang ◽

Tianzhuo Yu ◽

Ying Zhang ◽

Wenzhi Zhang ◽

...

Keyword(s):

Laser Ablation ◽

Adverse Effects ◽

Lymph Nodes ◽

Tuberculous Lymphadenitis ◽

Good Tolerability ◽

Minimal Invasiveness ◽

Contrast Enhanced ◽

The Mean ◽

Larger Sample

Objective This study was performed to assess the feasibility, effectiveness, and safety of percutaneous ultrasound (US)-guided laser ablation (LA) for the treatment of cervical tuberculous lymphadenitis (CTBL). Methods We retrospectively reviewed 11 patients with CTBL (mean age, 32.0 ± 8.6 years; range, 18–47 years) who underwent percutaneous US-guided LA from June 2014 to December 2016 with a subsequent 12-month follow-up. We assessed the mean volume reduction and contrast-enhanced US (CEUS) changes of the target lymph nodes as well as the tolerability and adverse effects of LA. Results The mean ablation energy was 522 ± 312 J (range, 204–1317 J). All 17 enrolled target lymph nodes were completely non-enhanced after LA treatment as detected by CEUS, indicating complete ablation of all lymph nodes (100%). The target lymph nodes significantly decreased in volume by a mean of 74.0% ± 15.6% from baseline to 12 months after LA. The LA procedure was well tolerated, and none of the 11 patients developed severe complications during the 12-month follow-up. Conclusion Percutaneous US-guided LA for the treatment of CTBL exhibits good tolerability, minimal invasiveness, and few adverse effects. Further investigations with larger sample sizes and longer follow-up periods are warranted to confirm these findings.

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CLO19-049: Central Lymph Node Dissection in the Clinically Node-Negative (cN0) Papillary Thyroid Carcinoma: Is it Necessary?

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2018.7143 ◽

2019 ◽

Vol 17 (3.5) ◽

pp. CLO19-049

Author(s):

Girish M. Suresh ◽

C. Ramachandra ◽

Ravi Arjunan ◽

Rajshekar Halkud

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Postoperative Complication ◽

Central Compartment ◽

Central Neck ◽

Papillary Thyroid ◽

Node Dissection ◽

Group A ◽

Group B

Background: Surgery is the treatment of choice in papillary thyroid cancer (PTC), which is the most common thyroid malignancy and frequently has metastases in the central compartment lymph nodes (CLN). There is debate among surgeons whether removing normal-appearing lymph nodes in the central neck (prophylactic lymph node dissection) is better than removing only the abnormal-appearing lymph nodes. Herein, we review the potential utility of central compartment lymph nodal dissection (CLND) on surgical outcome and disease-free follow-up of PTC and 5-year survival of patients operated on at our center. Methods: A total of 246 patients from February 2009 to March 2012 who were treated for PTC in our Kidwai Cancer Institution was analyzed retrospectively. 135 patients who underwent total thyroidectomy and CLND were assigned to Group A, which was compared with 111 patients who received total thyroidectomy, without CLND, who were assigned to Group B by evaluation of postoperative complications (recurrent laryngeal nerve damage, hoarseness, hypocalcemia, and hemorrhage rates) and recurrence at the time of Iodine131 treatment and subsequently at 60 months follow-up. Results: In the present study, Mean DFS and OS did not differ in both groups. Male gender and age more than 45 years had statistically significant DFS but without any impact on OS. There was a significant postoperative complication in group A compared to group B (P≤.001), with a very minimal recurrence in the central neck. 4 patients (3.6%) had recurrences in CLN. Conclusion: Considering the significant postoperative complication, which outweighs benefit, we conclude that for cN0 PTC, routine CLND is not necessary.

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Sensitivity rate of ultrasound (US)-guided fine-needle aspiration cytology (FNAC) using the Berlin morphology criteria for lymph node metastases to reduce the need for surgical sentinel node (SN) staging in melanoma.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.8535 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 8535-8535 ◽

Cited By ~ 1

Author(s):

Christiane A. Voit ◽

Alexander Christopher Jonathan Van Akkooi ◽

Saskia Gooskens ◽

Petra Siegel ◽

Gregor Schaefer-Hesterberg ◽

...

Keyword(s):

Lymph Node ◽

Clin Oncol ◽

Lymph Node Metastases ◽

High Sensitivity ◽

Needle Aspiration ◽

Tumor Burden ◽

Maximum Diameter ◽

Node Metastases ◽

Rotterdam Criteria

8535 Background: US-guided-FNAC prior to surgical SN staging is emerging as a possible cost-effective addition to the staging of melanoma patients (pts). Formerly, sensitivity (sens) rates of lymph node US in melanoma were disappointing (20–40%). The introduction of the Berlin Morphology Criteria has significantly improved sens rates for US-FNAC (J Clin Oncol 2010;28(5):847-52). The aim of the current study was to report on 1000 patients the sens, specificity (spec), positive (PPV) and negative (NPV) predictive value rates of US-FNAC from our prospective database with prolonged follow-up. Methods: Since 2001, >1000 stage I / II consecutive melanoma pts have undergone US-FNAC prior to SN. All patients underwent lymphoscintigraphy. Peripheral Perfusion (PP), Loss of Central Echoes (LCE), Balloon Shaped (BS) were the Berlin Morphology Criteria which were registered. FNAC was performed in case of presence of any of these factors. SN tumor burden was measured according to the Rotterdam Criteria. All patients underwent SN or LND in case of positive FNAC. Results: Mean/median Breslow thickness was 2.56 / 1.57 mm (0.2 – 44 mm).Mean/median follow-up was 39 / 32 months (0 – 115). Ulceration was present in 24 %. SN positivity rates were 20 % (202 / 1000). Sens was 51 %. Spec, PPV and NPV were 99%, 91% and 89%. Sensitivity was highest for T4 tumors (77%). PP, LCE, BS had sens of 69%, 24%, 25%. SN tumor burden > 1 mm in largest diameter according to the Rotterdam Criteria was identified by US-FNAC in 86%. Threshold for positive FNAC was 0.4 mm in maximum diameter. Conclusions: The new criterion of Periferal Perfusion is of key importance to achieve the high sensitivity of US-FNAC according to the Berlin Morphology Criteria (J Clin Oncol 2010; 28:847-852) to identify lymph node metastases. Especially for T4 patients and in patients with advanced SN tumor burden it can reduce significantly the need for surgical SN staging. The EORTC Melanoma Group will launch the prospective validation study, USE FNAC, in 2012.

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Diagnostic accuracy of PET scan in salvage lymph node resections in patients with prostate cancer (CaP).

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.6_suppl.215 ◽

2013 ◽

Vol 31 (6_suppl) ◽

pp. 215-215

Author(s):

David J. K. P. Pfister ◽

Charlotte Piper ◽

Daniel Porres ◽

Theodor Klotz ◽

Axel Heidenreich

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Diagnostic Accuracy ◽

Lymph Node Dissection ◽

Recurrent Disease ◽

Node Dissection ◽

Pet Ct ◽

Salvage Lymph Node Dissection ◽

Node Metastases

215 Background: PET-CT scans in patients with CaP are often used to identify either local recurrent disease or suspected lymph node metastases in early biochemical recurrent disease. The diagnostic accuracy is controversial. We want to show our experience of PET-CT and its diagnostic accuracy in salvage lymph node dissection. Methods: 21 patients treated with radical prostatectomy between 1997 and 2009 presented with PET-CT´s and biochemical recurrent disease and were treated by salvage lymph node dissection to prolong the time to either androgene deprivation or chemotherapy. Diagnostic accuracy was correlated per patient and per lymph nodes. Results: Mean PSA at time of lymph node dissection was 2,73 (0,4-8,4)ng/ml. 17 (81%) received prior radiotherapy and 6 (29%) received androgene deprivation. In total 203 lymph nodes were resected with 58 (29%) harbouring metastasis in 15 (71%) patients. This leads to a Sensitivity, Specifity, positive and negative predictive value of 69%, 12%, 76% and 88% concerning lymph node detection and 70%, 0%, 93% and 0% concerning the calculation per patient. At time of analysis follow-up was available in 5 patients with a biochemical recurrence free survival of 5 (3-12) months. Conclusions: The value of PET-CT in salvage lymph node dissection is under debate and must be questioned according to our results in this setting.

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Selective use of radioactive iodine therapy for papillary thyroid cancers with low or lower-intermediate recurrence risk

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa973 ◽

2020 ◽

Author(s):

Giorgio Grani ◽

Livia Lamartina ◽

Marco AlfÒ ◽

Valeria Ramundo ◽

Rosa Falcone ◽

...

Keyword(s):

Lymph Node ◽

Soft Tissues ◽

Distant Metastases ◽

Central Compartment ◽

Recurrence Risk ◽

Lymph Node Status ◽

Papillary Thyroid ◽

Extrathyroidal Invasion ◽

Node Metastases

Abstract Context Current guidelines recommend a selective use of radioiodine treatment (RAI) for papillary thyroid cancer (PTC). Objective To determine how policy changes affect the use of RAI and the short-term outcomes of patients. Design Retrospective analysis of longitudinal data. Setting Academic referral center. Patients Patients with non-aggressive PTC variants; no extrathyroidal invasion or limited to soft tissues, no distant metastases, and ≤5 central-compartment cervical lymph node metastases. In Cohort 1, standard treatments were total thyroidectomy and RAI (May 2005-June 2011); in Cohort 2 decisions on RAI were deferred for ~12 months after surgery (July 2011-December 2018). Propensity score matching was used to adjust for sex, age, tumor size, lymph node status, and extrathyroidal extension. Intervention Immediate RAI or deferred choice. Main outcome measures Responses to initial treatment in ≥3 years of follow-up. Results In Cohort 1, RAI was performed in 50/116 patients (51.7%), while in Cohort 2, it was far less frequent: immediately in 10/156 (6.4%), and in 3 more patients after the first follow-up data. The frequencies of structural incomplete response were low (1-3%), and there were no differences between the two cohorts at any follow-up visit. Cohort 2 patients had higher rates of “gray-zone responses” (biochemical incomplete or indeterminate response). Conclusions Selective use of RAI increases the rate of patients with “uncertain” status during early follow-up. The rate of structural incomplete responses remains low regardless of whether RAI is used immediately or not. Patients should be made aware of both the advantages and drawbacks of omitting RAI.

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A Rare Presentation of Autonomously Functioning Papillary Thyroid Cancer: Malignancy in Marine-Lenhart Syndrome Nodule

Case Reports in Surgery ◽

10.1155/2016/8740405 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Mehmet Uludag ◽

Nurcihan Aygun ◽

Alper Ozel ◽

Feyza Yener Ozturk ◽

Rabia Karasu ◽

...

Keyword(s):

Thyroid Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Papillary Thyroid Cancer ◽

Radical Neck Dissection ◽

Needle Aspiration ◽

Papillary Thyroid ◽

Rare Presentation ◽

Lateral Lymph Node ◽

Skip Metastases

Objective. Marine-Lenhart Syndrome (MLS) is defined as concomitant occurrence of autonomously functioning thyroid nodule (AFTN) with Graves’ disease (GD). Malignancy in a functional nodule is rare. We aimed to present an extremely rare case of papillary thyroid cancer in a MLS nodule with lateral lymph node metastases.Case. A 43-year-old male presented with hyperthyroidism and Graves’ ophthalmopathy. On Tc99m pertechnetate scintigraphy, a hyperactive nodule in the left upper thyroid pole was detected and the remaining tissue showed a mildly increased uptake. The ultrasonography demonstrated 15.5 × 13.5 × 12 mm sized hypoechoic nodule in the left upper pole of the thyroid and round lymph nodes on the left side of the neck. Fine needle aspiration biopsy (FNAB) of the nodule and lymph node revealed cytological findings consistent with papillary cancer. Total thyroidectomy with central and left modified radical neck dissection was performed. On pathologic examination, two foci of micropapillary cancer were detected. The skip metastases were present in three lymph nodes on the neck.Conclusion. AFTN can be seen rarely in association with GD. It is not possible to exclude malignancy due to the clinical and imaging findings. In the presence of suspicious clinical and sonographic features, FNAB should be performed.

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Utility of Gallium-67 in Determining the Radicality of Lymph Node Dissections of the Neck for Metastatic Lymph Nodes with Extranodal Spread in Patients Affected by Carcinoma of the Head and Neck

Tumori Journal ◽

10.1177/030089160008600402 ◽

2000 ◽

Vol 86 (4) ◽

pp. 273-276

Author(s):

Sante Basso Ricci ◽

Arturo Chiti ◽

Roberto Molinari ◽

Giuseppe Borsa ◽

Paolo Basso Ricci ◽

...

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Lymph Node Metastases ◽

Soft Tissues ◽

Postoperative Radiotherapy ◽

Control Group ◽

False Negatives ◽

Node Metastases ◽

Gallium 67

Aims and background Based on the fact that scintigraphy more readily reveals uptake of a radioisotope in a superficial position owing to incomplete surgical radicality, the authors examined by 67Ga scintigraphy a group of patients who had undergone dissection of lymph nodes of the neck from carcinoma with extranodal spread. They then checked the follow-up to ascertain the efficacy of 67Ga scintigraphy in relation to the eventual recurrences in the soft tissues of the neck. Methods A group of 136 patients were examined by 67Ga scintigraphy and followed for a minimum of 3 years after complementary radiotherapy. A group of 20 patients with no lymph node metastases was used as control to evaluate eventual false positives or false negatives. Results Recurrences in the soft tissues of the neck occurred in 35 (42.7%) of the 82 patients positive at 67Ga scintigraphy and in 6 (11.1%) of the 54 patients negative at the examination (P = 0.0001). All the patients in the control group were negative at 67Ga scintigraphy and without recurrences. Conclusions 67Ga scintigraphy can give reliable information on the risk of recurrences in the soft tissues of the neck. Since in spite of postoperative radiotherapy the percentage of local recurrences in cases with positive 67Ga scintigraphy was rather high (42.7%), the authors propose a scheme of radiotherapy based on administration of a higher dose per fraction on the scintigraphically positive area.

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LEVELS I–VII FOLLOWING THYROIDECTOMY FOR PAPILLARY THYROID CANCER

Siberian Journal of Oncology ◽

10.21294/1814-4861-2020-19-5-76-81 ◽

2020 ◽

Vol 19 (5) ◽

pp. 76-81

Author(s):

V. S. Parshin ◽

A. A. Veselova ◽

V. S. Medvedev ◽

S. A. Ivanov ◽

A. D. Kaprin

Keyword(s):

Thyroid Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Papillary Thyroid Cancer ◽

Lymph Node Metastases ◽

Cervical Lymph Node ◽

Papillary Thyroid ◽

Cervical Lymph Nodes ◽

Cervical Lymph Node Metastases ◽

Node Metastases

Introduction. Cervical lymph node metastases can occur not only in patients when they are first diagnosed with papillary thyroid cancer but also in patients who have undergone thyroidectomy. Objective. The aim of this study was to assess the potential utility of neck ultrasound in diagnosing cervical lymph node metastases (levels I–VII) in patients who underwent surgical treatment for papillary thyroid cancer.Material and Methods. B-mode sonography of all nodal levels in the neck was performed using a linear array transducer in the frequency range of 7.5–13 MHz, power mapping and panoramic scan to locate regional lymph node metastases. All lymph nodes removed during reoperations were submitted for histological evaluation. Sonographic examinations of cervical lymph nodes of the levels I–VII were performed in 2875 patients who had undergone thyroidectomy in different regions of the Russian Federation. The patients were admitted to our clinic to receive radioactive iodine therapy. All neck levels were assessed by ultrasound.Results. Sonography revealed cervical lymph node metastases in 267 (9.2 %) of 2875 patients with papillary thyroid cancer who had undergone thyroidectomy. Nodal metastasis in level VI only occurred in 70 (2.4 %) patients, in levels II–III–IV only in 150 (5.21 %), in level VB only in 32 (1.11 %), and at the same time in level VI and in levels II–III–IV in 15 (0.52 %) patients. There were no metastases in levels I, VA, VII of the neck. Solitary metastases to all levels were found in 7.5 %, multiple metastases in 1.2 %, and conglomerates in 0.6 % of cases. Solitary metastases in level VI were noted in 56 (1.9 %), in levels II–III–IV in 125 (4.3 %), and in level VB in 29 (1.0 %) patients. Multiple metastases in level VI were detected in 11 (0.38 %), in levels II–III–IV in 21 (0.73 %), and in level VB in 3 (0.1 %) patients. Median metastasis size was 2.1 ± 1.6 cm.Conclusion. Post-thyroidectomy patients were found to have cervical lymph node metastases. Ultrasound scanning of the neck should be considered a key examination if there are cicatricial changes as it enables to identify metastasis and to determine its location. The maximal number of metastases was noted in levels II–III–IV. Cervical lymph node metastases occurred less frequently in the central level and level VB. The predominant metastatic pattern was solitary. There was an essential difference in metastatic spread to cervical lymph nodes between postthyroidectomy patients and patients who were first diagnosed with papillary thyroid cancer.

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Mixed Medullary – Papillary Thyroid Carcinoma with mixed lymph node metastases: a case report

10.22541/au.160864545.55905855/v1 ◽

2020 ◽

Author(s):

Vanessa Guerreiro ◽

Cláudia Costa ◽

Joana Oliveira ◽

Ana Paula Santos ◽

Mónica Farinha ◽

...

Keyword(s):

Case Report ◽

Lymph Node ◽

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Lymph Nodes ◽

Papillary Carcinoma ◽

Lymph Node Metastases ◽

Papillary Thyroid ◽

Node Metastases

Medullary and papillary thyroid carcinoma are two distinct neoplasms. Its simultaneous is uncommon and its occurrence as a mixed follicular medullary carcinomas is extremely rare. We present a 60-year-old man with the mixed medullary-papillary carcinoma of the thyroid and papillary and medullary component metastases on lymph nodes.

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