Clinical Significance of Metastasis to the Central Compartment from Papillary Microcarcinoma of the Thyroid

Abstract

We previously demonstrated that for papillary microcarcinoma (PMC), (1) patients with lateral lymph node metastasis detected on preoperative ultrasonography (US) are more likely to develop recurrence, and (2) dissection of the lateral compartment does not improve the prognosis of patients without US-detectable lateral metastasis. In this study, we focused on metastasis from PMC to the central compartment. We investigated the clinical significance of lymph nodes in the central compartment using the same series of 600 patients as used in the previous study. Ultrasound-diagnosed central node metastasis could be found in 30 patients (20.0%). Although the specificity of US for detecting central node metastasis was 99.1%, sensitivity was only 10.9%. Neither US-diagnosed nor pathologically confirmed central node metastasis affected the disease-free survival (DFS) rate of PMC patients. Furthermore, in cases where PMC was located only in one lobe, central node dissection in the contralateral lobe did not improve the DFS rate. These findings suggest that, for PMC, (1) US is an insensitive technique for detecting the central node metastasis, (2) the presence of central node metastasis is unrelated to DFS of patients, and (3) when performing lobectomy for PMC involving only one lobe, dissection of the central compartment in the contralateral lobe is optional.

Prediction of central lymph node metastasis in 392 patients with cervical lymph node-negative papillary thyroid carcinoma in Eastern China

“…The present study demonstrated a significant association between male gender and CLNM, which is consistent with these previous reports. Tumor size has been previously confirmed as a prognostic feature of CLNM (20). Lee et al (28) demonstrated that PTMC with tumor size >7 mm had a stronger association with poor prognosis compared with those <7 mm.…”

“…A number of authors have proposed that there should be routine CND in patients with PTMC since there is evidence demonstrating that residual metastases in cervical lymph nodes represent the most common site of recurrent disease, and repeated operations may increase the incidence of operative complications, including hypoparathyroidism and damage to the laryngeal nerve (19). However, a previous study indicated that CND is not required, as the presence of CLNM is not associated with the disease-free survival rate of patients (20). The present study focused on identifying the preoperative and intraoperative predictive factors for CLNM in cN0 PTMC patients, which may aid in identifying approaches to appropriate surgical treatment for patients in Eastern China.…”

“…The present study focused on identifying the preoperative and intraoperative predictive factors for CLNM in cN0 PTMC patients, which may aid in identifying approaches to appropriate surgical treatment for patients in Eastern China. Although the use of thyroid US for detecting CLNM is limited (20), the present study also investigated characteristics of US to identify any potential predictors.…”

Diagnostic Accuracy of PET/MR for Evaluating Central Lymph Node Status in Patients with Papillary Thyroid Carcinoma

“…Despite reported low sensitivity in cases of deeply located LN or small LN metastases (LNMs), the most commonly used preoperative modalities for detecting suspected LNs are ultrasonography (US) and computed tomography (CT) (6,7). Various alternative imaging modalities have been introduced to increase the sensitivity of the detection of metastatic LNs, such as magnetic resonance imaging (MRI) or 18 F-fluorodeoxyglucosepositron emission tomography (FDG-PET), despite problems associated with poor costeffectiveness.…”

Impact of Routine Unilateral Central Neck Dissection on Preablative and Postablative Stimulated Thyroglobulin Levels after Total Thyroidectomy in Papillary Thyroid Carcinoma

“…[4][5][6][7][8][9][10] The arguments for it include improved pathological staging accuracy, preoperative failure to reliably detect central lymph node metastasis, and avoidance of central compartment reoperations. 3,4,11 On the other hand, arguments against it include increased surgical morbidities such as hypoparathyroidism and recurrent laryngeal nerve (RLN) injury; most important of all, prophylactic CND has not been shown to reduce recurrence or mortality rate. 9,10,[12][13][14] There have been no randomized, controlled studies showing that prophylactic CND reduces recurrence or improves survival.…”