Clinical and Pathologic Predictors of Lymph Node Metastasis and Recurrence in Papillary Thyroid Microcarcinoma

Siddiqui, Saaduddin; White, Michael G.; Antic, Tatjana; Grogan, Raymon H.; Angelos, Peter; Kaplan, Edwin L.; Cipriani, Nicole A.

doi:10.1089/thy.2015.0429

Cited by 160 publications

(133 citation statements)

References 25 publications

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“…Five studies were conducted in the Republic of Korea [16, 17, 21, 22, 24], one in Spain [18], five in Italy [19, 23, 25, 26, 29], one in Taiwan [20], one in United State of American [27], and one in Turkey [28]. Thirteen reports were retrospective studies [19–25, 27–29], and one was prospective study [26]. The follow up durations for the recurrence of PTMC range from 2 to 24 years and the study sample sizes range from 81 to 2018 (Table 1).…”

Section: Resultsmentioning

confidence: 99%

A meta-analysis on the effect of operation modes on the recurrence of papillary thyroid microcarcinoma

Song

Huang

et al. 2016

Oncotarget

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Whether total thyroidectomy reduces the recurrence rate in patients with papillary thyroid microcarcinoma (PTMC) is currently controversy. Conclusions of sporadic, inconsistent, and mono-institutional studies need a meta-analysis to evaluate. 525 relevant studies were obtained from initial search on PubMed, 511 studies were excluded by inclusion and exclusion criteria. Eligible data were extracted from each included study. The Odds ratios (ORs) and 95% confidence interval (CI) were used to assess the difference in the recurrence rates between PTMC patients treated with total thyroidectomy and non-total thyroidectomy. OR and 95% CI were calculated using a fixed-effects or a random-effects model. The Q statistic was used to evaluate homogeneity and Beggs test was used to assess publication bias. 14 studies meeting the inclusion criteria were included in this meta-analysis. The over all recurrence rates of pooled patients with total thyroidectomy and non-total thyroidectomy were 2.83% and 2.84% respectively. Primary random-effects model analysis showed, no significant difference of recurrence rates existed between two operation modes (OR = 0.732, 95% CI: 0.444 - 1.208), while, high heterogeneity among studies was found, I-squared index (I2) = 40.2%. After remove one study with high heterogeneity, the OR of the pooled recurrence rates of the total thyroidectomy and the non-total thyroidectomy groups was 0.786 (95% CI: 0.363 - 1.701), further suggesting no significant difference of the recurrence rate exists between two operation modes. Our meta-analysis demonstrated postoperative recurrence of PTMC is not reduced by total thyroidectomy, non-total thyroidectomy is also a good choice to treat PTMC patients.

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Section: Resultsmentioning

confidence: 99%

A meta-analysis on the effect of operation modes on the recurrence of papillary thyroid microcarcinoma

Song

Huang

et al. 2016

Oncotarget

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“…Vorasubin et al (27) recently demonstrated that large, multifocal, and capsularly or lymphovascularly invasive PTMC was significantly associated with at least a 1.93 times greater risk of metastasizing than were smaller, solitary, and noninvasive tumors. Another study by Siddiqui et al (28) showed that younger age (age < 45 years), multifocality, and extrathyroidal extension were predictors of CLNM. Our data showed that male sex and tumor size were not predictive for CLNM, in contrast to findings by others (18,29,30).…”

Section: Discussionmentioning

confidence: 96%

Prediction of central lymph node metastasis in patientswith thyroid papillary microcarcinoma

Akın¹,

Aksoy²,

Akın³

et al. 2017

Turk J Med Sci

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Background/aim: The purpose of this study was to analyze the clinicopathological characteristics of patients with papillary thyroid carcinoma (PTC) and papillary thyroid microcarcinoma (PTMC) and predictive factors for central lymph node metastasis (CLNM). Materials and methods:Patients diagnosed as having PTC and PTMC were evaluated. Clinical and laboratory parameters were recorded. Results:The mean age at diagnosis was 47.3 ± 11.9 years. Of all 223 patients, 91 (40.8%) had lymph nodes removed, 29 of whom had lymph node metastasis and 24 of whom had only CLNM. Univariate analysis revealed that central lymph node metastasis was associated with male sex, presence of bilaterality, presence of extrathyroidal extension, and tumor size (P = 0.033, P = 0.027, P < 0.001, P < 0.001, respectively). However, multivariate logistic regression analysis showed that sex, age, tumor size, multifocality, bilaterality, extrathyroidal extension, clinical suspicion, and chronic lymphocytic thyroiditis were not significantly correlated with an increased risk for CLNM. Conclusion:Lymph node metastasis is known to be a significant predictor of locoregional recurrence in patients with PTC and PTMC. Further prospective studies are needed to identify the extent of surgery such as central lymph node dissection in patients with PTC or PTMC.

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“…In fact, AS strategy in low-risk PTMC has been suggested by a Japanese group based on single observational studies, and concerns remain about disease progression during AS, especially in patients with an aggressive phenotype 17–19. Although AS has existed for approximately 10 years, it was only recently added to the international guidelines as a viable management strategy 5,14.…”

Section: Discussionmentioning

confidence: 99%

Long-term oncologic outcomes of papillary thyroid microcarcinoma according to the presence of clinically apparent lymph node metastasis: a large retrospective analysis of 5,348 patients

Choi¹,

Lee²,

Lee³

et al. 2018

CMAR

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PurposeActive surveillance (AS) of low-risk papillary thyroid microcarcinoma (PTMC) may reduce the risk of overtreatment of clinically insignificant cancer. However, the absence of predictor for the progression of PTMC resulted in treatment delay and potentially compromising cure of aggressive disease. Therefore, to anticipate potential damage of delayed surgery, we investigated the oncologic outcomes of patients with low-risk PTMC initially eligible for AS except clinically apparent lymph node metastasis (LNM), imitating delayed surgery with neck dissection.Materials and methodsA total of 5,348 patients, enrolled between 1987 and 2016, with low-risk PTMC initially eligible for AS were included regardless of LNM. We classified our study patients into two groups: Group I, lobectomy with prophylactic central cervical node dissection; Group II, total thyroidectomy with modified radical neck dissection for LNM. In addition, we investigated the oncological outcomes of patients with second-wave surgery due to lateral lymph node recurrence (Group III, subgroup of Group I).ResultsGroup I showed more favorable clinicopathological characteristics compared with Group II. In Group I, only 29 (0.58%) of 4,927 patients underwent second-wave surgery with neck dissection for lateral lymph node recurrences, whereas in Group II, all 22 (5.23%) of 421 patients underwent second-wave selective node dissection because of nodal recurrence. Disease-free survival rates were significantly different between Groups I and II (P<0.05). Of note, the recurrence rate of Group II was still significantly higher than that of Group III (5.2% vs 0%, respectively; P=0.021). In addition, Kaplan–Mayer survival analysis indicated poor disease-free survival rates in Group II compared with Group III (P<0.05).ConclusionThe long-term treatment outcome of PTMC without LNM was favorable even if the recurrence occurs during follow-up period compared with that of PTMC with LNM. It should be noted that AS might be able to cause poor prognosis due to clinically apparent LNM.

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Clinical and Pathologic Predictors of Lymph Node Metastasis and Recurrence in Papillary Thyroid Microcarcinoma

Cited by 160 publications

References 25 publications

A meta-analysis on the effect of operation modes on the recurrence of papillary thyroid microcarcinoma

A meta-analysis on the effect of operation modes on the recurrence of papillary thyroid microcarcinoma

Prediction of central lymph node metastasis in patientswith thyroid papillary microcarcinoma

Long-term oncologic outcomes of papillary thyroid microcarcinoma according to the presence of clinically apparent lymph node metastasis: a large retrospective analysis of 5,348 patients

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