A Diagnostic Dilemma: Skip Metastasis in Papillary Thyroid Cancer

Özden, Sabri; Çomçalı, Bülent; Ataş, Hakan; Er, Sadettin; Tez, Mesut; Saylam, Barış

doi:10.1177/000313482008600335

Cited by 8 publications

(3 citation statements)

References 25 publications

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“…Older age is a risk factor for both PTC [17][18][19] and LLNM. 20,21 Wang et al concluded that age ≥55 years was an independent risk factor for SLNM, which is consistent with the findings of this study. 13 There is still controversy regarding the size and invasiveness of tumors in SLNM patients.…”

Section: Discussionsupporting

confidence: 92%

Nomogram for predicting skip metastasis in cN0 papillary thyroid cancer patients at increased risk of lymph node metastasis

Li¹,

Zhou²,

Zhu³

et al. 2023

Adv Clin Exp Med

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Background. Skip lymph node metastasis (SLNM) refers to lateral lymph node metastasis (LLNM) without involving central lymph node (CLN). Some microscopic nodal positivity may be difficult to detect before surgery due to atypical imaging characteristics. These patients are misdiagnosed as having clinically nodenegative (cN0) papillary thyroid cancer (PTC) even after central lymph node dissection, leading to a high risk of developing LNM after surgery. Current prediction models have limited clinical utility, as they are only applicable to predict SLNM from clinically node-positive (cN+) PTC, not cN0 PTC, and this has little impact on treatment strategies.Objectives. This study aimed to establish a nomogram for preoperatively assessing the likelihood of SLNM in cN0 PTC patients with increased risk of LNM, thus optimizing their therapeutic options. Materials and methods.The records of 780 PTC patients undergoing thyroidectomy along with bilateral central lymph node dissection were retrospectively reviewed. The cN0 patients with postoperative LLNM (occult SLNM) and cN+ patients without central lymph node metastasis (CLNM) (typical SLNM) were included in the SLNM group (n = 82). The CLNM-negative cN0 patients without postoperative LLNM were assigned to the non-SLNM group (n = 698). The independent correlates of SLNM constituted the nomogram for determining the likelihood of SLNM in high-risk cN0 PTC patients.Results. The independent correlates of SLNM were age (hazard ratio (HR) = 1.016), tumor location (HR = 1.801), tumor size (HR = 1.528), and capsular invasion (HR = 2.941). They served as components in the development of the nomogram. This model was verified to present acceptable discrimination. It showed good calibration and a decent net benefit when the predicted probability was <60%.Conclusions. We developed a nomogram incorporating preoperative clinical data to predict the probability of SLNM development in high-risk cN0 PTC patients, which contributed to their optimized treatment options.

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Section: Discussionsupporting

confidence: 92%

Nomogram for predicting skip metastasis in cN0 papillary thyroid cancer patients at increased risk of lymph node metastasis

Li¹,

Zhou²,

Zhu³

et al. 2023

Adv Clin Exp Med

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“…In the univariate and multivariate analyses, the rate of skip metastasis was significantly higher in patients with a tumour size ≤10 mm (P = 0.033), upper tumour location (P = 0.006) and fewer CLNDs (P = 0.005). Previously, many studies ( 18 , 20 , 23 ) have reported that skip lymph node metastasis is associated with tumour size, and skip metastasis is often found to be more common in PTC patients with a tumour size ≤1 cm. Several of these studies ( 15 , 24 , 25 ) found that the location of the tumour in the upper pole is one of the independent risk factors for the development of skip metastasis in patients with PTC.…”

Section: Discussionmentioning

confidence: 99%

Predicting skip metastasis in lateral lymph nodes of papillary thyroid carcinoma based on clinical and ultrasound features

et al. 2023

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BackgroundSkip metastasis in papillary thyroid cancer (PTC), defined as lateral lymph node metastasis (LLNM) without the involvement of central lymph node metastasis (CLNM), is generally unpredictable. Our study aimed to develop a model to predict skip metastasis by using clinicopathological and ultrasound factors of PTC.MethodsWe retrospectively reviewed the medical records of patients who underwent total thyroidectomy and central lymph node dissection (CLND) plus lateral lymph node dissection (LLND) between January 2019 and December 2021 at the First Affiliated Hospital of Soochow University. Furthermore, univariate and multivariate analyses assessed the clinical and ultrasound risk factors. Receiver operating characteristic (ROC) curves were used to find the optimal cut-off values for age and dominant nodule diameter. Multivariate logistic regression analysis results were used to construct a nomogram and were validated internally.ResultsIn all patients, the skip metastasis rate was 15.4% (41/267). Skip metastasis was more frequently found in patients with a tumour size ≤10 mm (OR 0.439; P = 0.033), upper tumour location (OR 3.050; P=0.006) and fewer CLNDs (OR 0.870; P = 0.005). After analysing the clinical and ultrasound characteristics of the tumour, five factors were ultimately associated with lateral lymph node skip metastasis and were used to construct the model. These factors were an age >40 years, tumour diameter <9.1 mm, upper tumour location, non-smooth margin and extrathyroidal extension. The internally evaluated calibration curves indicated an excellent correlation between the projected and actual skip metastasis probability. The nomogram performed well in discrimination, with a concordance index of 0.797 (95% CI, 0.726 to 0.867).ConclusionsThis study screened for predictors of skip metastasis in PTC and established a nomogram that effectively predicted the risk of potential skip metastasis in patients preoperatively. The method can predict and distinguish skip metastases in PTC in a simple and inexpensive manner, and it may have future therapeutic utility.

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“…Thyroid cancer is one of the most common malignant tumors in the endocrine system 1 and has registered an annual growth rate of 2% in recent decades. 2 Papillary thyroid cancer (PTC) is the most common type of malignant thyroid tumor, with more than 10 known subtypes that account for 85-90% of all thyroid malignancies. 3,4 Fortunately, most PTCs are relatively inert and the 10-year survival rate for patients undergoing a glandectomy or total thyroidectomy plus I131 treatment is greater than 95%.…”

Section: Introductionmentioning

confidence: 99%

A comprehensive expression profile of tRNA‐derived fragments in papillary thyroid cancer

Shan

Wang

Zhu

2020

Clinical Laboratory Analysis

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Background: The incidence of thyroid cancer has been on a rise. Papillary thyroid cancer (PTC) is the most common type of malignant thyroid tumor and accounts for approximately 85% of thyroid cancer cases. Although the genetic background of PTC has been studied extensively, relatively little is known about the role of small noncoding RNAs (sncRNAs) in PTC. tRNA-derived fragments (tRFs) represent a newly discovered class of sncRNAs that exist in many species and play key roles in various biological processes. Methods: In this study, we used high-throughput next-generation sequencing technology to analyze the expression of tRFs in samples from PTC tissues and normal tissues. We selected four tRFs to perform qPCR to determine the expression levels of these molecules and make bioinformatic predictions. Results: We identified 53 unique tRFs and transfer RNA halves (tsRNAs). The 10 most upregulated tRFs and tsRNAs were tRF-39-I6D3887S1RMH5MI2, tRF-21-2E489B3RB, tRF-18-JMRPFQDY, tRF-17-202L2YF, tRF-17-VBY9PYJ, tRF-18-YRRHQFD2, tRF-21-WE884U1DD, tRF-41-EX2Z10I9BZBZOS4YB, tRF-39-HPDEXK7S1RNS9MI2, and tRF-20-1SS2P46I. The 10 most downregulated tRFs and tsRNAs were tRF-31-HQ 9M739P-8WQ0B, tRF-43-5YXENDBP1IUUK7VZV, tRF-38-RZYQHQ9M739P8WD8, tRF-25-9M739P8WQ0, tRF-33-V6Z3M8ZLSSXUD6, tRF-27-MY73H3RXPLM, tRF-26-DBNIB9I1KQ0, tRF-38-Z9HMI8W47W1R7HX, tRF-40-Z6V6Z3M8ZLSSXUOL, and tRF-39-YQHQ9M739P8WQ0EB. qPCR verification of cell lines and tissue samples yielded results consistent with the sequencing analysis. As tRF-39 expression showed the maximum difference between PTC cells and normal cells, we chose this tRF to predict targets and perform functional tRF and tsRNA enrichment analysis. Conclusion: In this study, we provided a comprehensive catalog of tRFs involved in PTC and assessed the abnormal expression of these fragments. Through qPCR verification, tRF-39-0VL8K87SIRMM12E2 was found to be the most significantly upregulated tRF. Further tRF and enrichment analysis revealed that tRF-39 was mostly enriched in the "metabolic pathways." These preliminary findings can be used as the basis for further research studies based on the functional role of tRFs in patients with PTC. K E Y W O R D S expression profile, papillary thyroid cancer, tRNA-derived fragments This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. How to cite this article: Shan S, Wang Y, Zhu C. A comprehensive expression profile of tRNA-derived fragments in papillary thyroid cancer.

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A Diagnostic Dilemma: Skip Metastasis in Papillary Thyroid Cancer

Cited by 8 publications

References 25 publications

Nomogram for predicting skip metastasis in cN0 papillary thyroid cancer patients at increased risk of lymph node metastasis

Nomogram for predicting skip metastasis in cN0 papillary thyroid cancer patients at increased risk of lymph node metastasis

Predicting skip metastasis in lateral lymph nodes of papillary thyroid carcinoma based on clinical and ultrasound features

A comprehensive expression profile of tRNA‐derived fragments in papillary thyroid cancer

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