Central Lymph Node Metastasis Is an Important Prognostic Factor in Patients with Papillary Thyroid Microcarcinoma

Lee, Jeonghun; Song, Yeongpeck; Soh, Euy Young

doi:10.3346/jkms.2014.29.1.48

Cited by 62 publications

(56 citation statements)

References 28 publications

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“…Papillary thyroid microcarcinoma (PTMC), which is defined as a papillary carcinoma with the dimensions equal to or <1.0 cm, according to the World Health Organization classification (4), accounts for 6–35% of thyroid carcinoma and 35.7–61.5% of papillary thyroid carcinoma (PTC) (5–10). PTMC is considered with favorable biological features and good long-term prognosis, as the 10-year disease-specific survival of 99.5% (11).…”

Section: Introductionmentioning

confidence: 99%

Clinicopathological features for predicting central and lateral lymph node metastasis in papillary thyroid microcarcinoma: Analysis of 66 cases that underwent central and lateral lymph node dissection

Tao

Wang

et al. 2016

Molecular and Clinical Oncology

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Currently the surgical approach for papillary thyroid microcarcinoma (PTMC), particularly the range of lymph node dissection, remains controversial. The present study aims to evaluate the risk factors for central and lateral lymph node metastasis (CLNM and LLNM) for appropriate clinical decision of neck lymph node dissection in PTMC. A total of 66 cases of PTMC that underwent unilateral or bilateral lobectomy plus prophylactic cervical lymph node dissection were collected for clinicopathological evaluation, including age, gender, tumor size, subtypes, extrathyroidal invasion, multifocality, calcifications, loss of cellular polarity/cohesiveness (LOP/C) in the invasive front, CLNM and LLNM, and retrospectively analysis. Univariate analysis revealed that LOP/C was significantly associated with CLNM (P=0.001) and LLNM (P<0.0001). The male gender was a risk factor of CLNM (P=0.04), while the age <45 years, tumor size >0.5 cm and multifocality were high-risk factors of LLNM (P=0.022, 0.044 and 0.005, respectively). Multivariable analysis revealed that LOP/C was significantly associated with CLNM [P=0.007, odds ratio (OR)=7.765, 95% confidence interval (CI)=1.773–33.996] and LLNM [P=0.029, OR=5.717, 95% CI=1.190–27.470]. Both multivariable analysis and χ2 test revealed that CLNM was another important high-risk factor of LLNM (P=0.021, OR=5.444, 95% CI=1.290–22.969, χ2=17.867, P<0.001). The present study revealed that prophylactic central lymph node dissection is essential for PTMC surgery and that prophylactic lateral lymph node dissection is recommend for patients with LOP/C and CLNM, which can be performed by intraoperative frozen section pathological examination. This must be considered discreetly in the case of patients with age <45 years, tumor size >0.5 cm and multifocal lesions.

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Section: Introductionmentioning

confidence: 99%

Clinicopathological features for predicting central and lateral lymph node metastasis in papillary thyroid microcarcinoma: Analysis of 66 cases that underwent central and lateral lymph node dissection

Tao

Wang

et al. 2016

Molecular and Clinical Oncology

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“…Besides providing objective information about LN status, CLND has also value to reduce postoperative Tg levels and local recurrence rates. 10,11 Secondary benefit of pCLND would be minimizing patients' anxiety about a secondary operation. 2 Add to this the low accuracy of preoperative diagnostic tools in identifying nodal involvement, led several authors to consider CLND especially when dealing with recurrent disease.…”

Section: Introductionmentioning

confidence: 99%

Papillary thyroid carcinoma, evaluation of prophylactic central compartment’s dissection versus conservative management: a prospective study

Ali

Abdelhameed

2018

Int Surg J

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INTRODUCTIONPTC is the most common well differentiated thyroid carcinoma (WDTC) and is considered a relatively indolent tumor.1 This relatively benign Behavior has led to a concept that CLND would not affect survival rates.2 Despite this, regional lymph node (LN) metastases are frequent in PTC occurring in 20% to 90% of patients. 3The pattern of LN metastasis takes place in a sequential manner; involving the central compartment (level VI) first with a frequency reaching 90% including micrometastases, followed by the ipsilateral lateral compartment and then the contralateral lateral compartment and the mediastinal LN. 4,5 Although there is consensus of block node dissection in node positive patients there is controversy about the benefits of elective CLND in N0 PTC. 6 Patients have a ABSTRACTBackground: Papillary thyroid carcinoma (PTC) is one of the commonest thyroid cancers. While there is consensus of block node dissection in nodal positive patients, there is controversy in dealing with nodal negative patients regarding the need of block node dissection. We aimed to evaluate prophylactic central lymph node dissection (pCLND) versus conservative management in PTC with N0 neck. Methods:This was a prospective randomized study conducted at General Surgery Department, Sohag University Hospital, from August 2013 to September 2017. It included fifty-five patients diagnosed to have PTC with N0 neck randomly divided into two groups; (Group A) included 25 patients who underwent total thyroidectomy (TT) alone and (Group B) included 30 patients who underwent TT with pCLND. We compared both groups regarding the operative and post-operative outcomes.Results: There was temporary hypoparathyroidism with an incidence of 12% for Group A and 23% for Group B (P=0.01). Permanent hypocalcemia occurred in 1 patient in each group (P=0.75). Unilateral recurrent laryngeal nerve (RLN) temporary palsy occurred in 10% for Group B patients and in 8% for Group A patients, (P=0.46). Node metastases were observed in 43% in group B upstaging the disease. Both univariate and multivariate analyses showed that CLN metastasis was significantly associated with age <45, male gender, tumor size >2.0cm, bilaterality, and multifocality. Locoregional recurrence was observed in 4% of patients in group A and in 0% in B.Conclusions: TT+pCLND is a safe treatment in patients with N0 PTC and it can be done without a high complication rate and without recurrence compared to TT without CLND.

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“…Some studies have shown a higher risk of recurrence in the case of family aggregation of PTC compared to sporadic PTC (5-10), but this observation is not confirmed in all studies (14)(15)(16)(17)(18)(19)(20). There is even greater controversy to know whether the possible increased risk is due to the more aggressive initial presentation or whether a family history itself is an independent risk factor for recurrence (14).…”

Section: Discussionmentioning

confidence: 99%

Should a family history of papillary thyroid carcinoma indicate more aggressive therapy in patients with this tumor?

Rosário

Calsolari

2014

Arq Bras Endocrinol Metab

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Objective To determine whether the currently recommended therapy for papillary thyroid carcinoma (PTC) that show no classical factors indicating a poor prognosis is also effective in cases with a family history of this tumor. Subjects and methods: Forty-two patients were studied; 10 were submitted to lobectomy and 32 to total thyroidectomy, including 23 without lymph node dissection and 9 with lymph node dissection. None of the patients received radioiodine or was maintained under TSH suppression. Results No case of recurrence was detected by imaging methods and there was no increase in thyroglobulin or antithyroglobulin antibodies during follow-up (24 to 72 months). Conclusion The treatment usually recommended for patients with PTC does not need to be modified in the presence of a family history of this tumor if no factors indicating a poor prognosis are present (tumor ≤2 cm, non-aggressive histology, no extensive extrathyroid invasion or important lymph node involvement, complete tumor resection, no evidence of persistent disease after surgery).

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Central Lymph Node Metastasis Is an Important Prognostic Factor in Patients with Papillary Thyroid Microcarcinoma

Cited by 62 publications

References 28 publications

Clinicopathological features for predicting central and lateral lymph node metastasis in papillary thyroid microcarcinoma: Analysis of 66 cases that underwent central and lateral lymph node dissection

Clinicopathological features for predicting central and lateral lymph node metastasis in papillary thyroid microcarcinoma: Analysis of 66 cases that underwent central and lateral lymph node dissection

Papillary thyroid carcinoma, evaluation of prophylactic central compartment’s dissection versus conservative management: a prospective study

Should a family history of papillary thyroid carcinoma indicate more aggressive therapy in patients with this tumor?

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