Lymph node metastasis around the entrance point to recurrent laryngeal nerve in papillary thyroid carcinoma

Background: There were are few reports on the lymph nodes of entrance point to recurrent laryngeal nerve (LN-epRLN) in the patients with papillary thyroid carcinoma (PTC). Therefore,Thus, we investigated the clinical significance of aimed to increase acknowledgement of LN-epRLN and implications it may have.explore clinical implication. Methods: A prospective observational analysis including of 878 consecutive patients with PTC who underwent thyroidectomy from April 2016 to March 2017 was conductedperformed. We explored the surrounding tissue of laryngeal entry pointentrance point to recurrent laryngeal nerve, during routine central lymph node dissection (CLND). The lymph node specimens were sent separately for routine histopathological examination. Thereafter, , and the complications and follow-ups were recorded. Results: LN-epRLNs was were found in 73 of the 878 patients, with and the metastasis metastatic rate of was 3.76%. In univariate analysis, LN-epRLN metastasis was correlated with further central nodal metastasis, tumor location in the upper third of the thyroid and tumor multifocality. Univariate and multivariate analysis showed central lymph node metastases can serve as independent predictors for LN-epRLN metastasis. Conclusions: LN-epRLN can be the site of metastasis of PTC, and the positive LN-epRLN was highly predictive of other central nodal metastasis. LN-epRLN metastases in PTC were also associated with tumor location in the isthmus or upper third of the thyroid and tumor multifocality. In our study, we focus on acknowledgement of LN-epRLN. We emphasized the value of exactitude anatomy and the thoroughness of CLND for cN0-1a PTC.In summary, we confirmed the significance of LN-epRLN in metastasis and recurrence, which required precise anatomy and thorough CLND. In PTC patients, especially in suspicious presence of central cervical lymph node metastasis, attention should be given to excising the nodal tissue at the laryngeal entry point.

Lymph node metastasis around the entrance point to recurrent laryngeal nerve in papillary thyroid carcinoma

Background: There were few reports on the lymph nodes of entrance point to recurrent laryngeal nerve (LN-epRLN) in the patients with papillary thyroid carcinoma (PTC). Therefore, we aimed to increase acknowledgement of LN-epRLN and explore clinical implication. Methods: A prospective analysis including 878 consecutive patients with PTC who underwent thyroidectomy from April 2016 to March 2017 was performed. We explored the surrounding tissue of entrance point to recurrent laryngeal nerve, during routine central lymph node dissection (CLND). The lymph node specimens were sent separately for routine histopathological examination, and the complications and follow-ups were recorded. Results: LN-epRLN was found in 73 of the 878 patients and the metastasis rate was 3.76%. In univariate analysis, LN-epRLN metastasis was correlated with further central nodal metastasis, tumor location in the upper third of the thyroid and tumor multifocality. Conclusions: LN-epRLN can be the site of metastasis of PTC, and the positive LN-epRLN was highly predictive of other central nodal metastasis. LN-epRLN metastases in PTC were also associated with tumor location in the isthmus or upper third of the thyroid and tumor multifocality. In our study, we focus on acknowledgement of LN-epRLN. We emphasized the value of exactitude anatomy and the thoroughness of CLND for cN0-1a PTC.

Lymph node metastasis around the entrance point to recurrent laryngeal nerve in papillary thyroid carcinoma

Background There were few reports on the lymph nodes of entrance point to recurrent laryngeal nerve (LN-epRLN) in patients with papillary thyroid carcinoma (PTC). Therefore, we aimed to increase awareness of LN-epRLN. Methods A prospective analysis including 878 consecutive patients with PTC who underwent thyroidectomy from April 2016 to March 2017 was performed. We explored the surrounding tissue of entrance point to recurrent laryngeal nerve, during routine central lymph node dissection (CLND). The lymph node specimens were sent separately for routine histopathological examination, and the complications and follow-ups were recorded. Results LN-epRLN was found in 73 of the 878 patients and the metastasis rate was 3.76%. In univariate analysis, LN-epRLN metastasis was correlated with further central nodal metastasis, tumor location in the upper third of the thyroid and tumor multifocality. Conclusions LN-epRLN can be the site of metastasis of PTC. CLND scope should include the surrounding tissue of entrance point to recurrent laryngeal nerve. LN-epRLN metastasis in PTC is associated with tumor location in the isthmus or upper third of the thyroid, tumor multifocality and further central nodal metastasis.

Is BRAFV600E mutation a marker for central nodal metastasis in small papillary thyroid carcinoma?

Utilizing BRAFV600E mutation as a marker may reduce unnecessary prophylactic central neck dissection (pCND) in clinically nodal negative (cN0) neck for small (≤2 cm) classical papillary thyroid carcinoma (PTC). We aimed to assess whether BRAF is a significant independent predictor of occult central nodal metastasis (CNM) and its contribution to the overall prediction after adjusting for other significant preoperative clinical factors in small PTC. Primary tumor tissue (paraffin-embedded) from 845 patients with small classical cN0 PTC who underwent pCND was tested for BRAF mutation. Clinicopathologic factors were compared between those with and without BRAF. BRAF was evaluated to see if it was an independent factor for CNM. Prediction scores were generated using logistic regression models and their predictability was measured by the area under the ROC curve (AUC). The prevalence of BRAF was 628/845 (74.3%) while the rate of CNM was 285/845 (33.7%). Male sex (odds ratio (OR): 2.68, 95% CI: 1.71–4.20), large tumor size (OR: 2.68, 95% CI: 1.80–4.00), multifocality (OR: 1.49, 95% CI: 1.07–2.09), lymphovascular permeation (OR: 10.40, 95% CI: 5.18–20.88), and BRAF (OR: 1.65, 95% CI: 1.10–2.46) were significant independent predictors of CNM, while coexisting Hashimoto's thyroiditis (OR: 0.56, 95% CI: 0.40–0.80) was an independent protective factor. The AUC for prediction score based on tumor size and male sex was similar to that of prediction score based on tumor size, male sex, and BRAF status (0.68 vs 0.69, P=0.60). Although BRAF was an independent predictor of CNM, knowing its status did not substantially improve the overall prediction. A simpler prediction score based on male sex and tumor size might be sufficient.