Completion Total Thyroidectomy Is Not Necessary for Papillary Thyroid Microcarcinoma with Occult Central Lymph Node Metastasis: A Long-Term Serial Follow-Up

Choi, Soon Min; Kim, Jin Kyong; Lee, Cho Rok; Lee, Jandee; Jeong, Jong Ju; Nam, Kee Hyun; Chung, Woong Youn; Kang, Sang–Wook

doi:10.3390/cancers12103032

Cited by 6 publications

(3 citation statements)

References 70 publications

(77 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…LN metastasis, one of the criteria for categorizing DTC as ATA intermediate risk, is very common in patients with DTC and is observed in up to 80% of cases (28,29). It remains controversial whether occult LN micrometastasis is associated with recurrence, although it is not associated with disease-specific mortality (30)(31)(32). Our study showed that LN micrometastasis was not associated with the recurrence rate.…”

Section: Discussionmentioning

confidence: 49%

Thyroid lobectomy is sufficient for differentiated thyroid cancer with upgraded risk after surgery

Choi¹,

Kim²,

Lee³

et al. 2022

Gland Surg

Self Cite

View full text Add to dashboard Cite

Background: It is difficult to reliably distinguish between American Thyroid Association (ATA) low-risk and intermediate-risk differentiated thyroid cancer (DTC) before surgery. Therefore, physicians are faced with a dilemma regarding the necessity and timing of completion total thyroidectomy (CT) after thyroid lobectomy (TL). We evaluated proper surgical methods by analyzing oncologic outcomes of TL in patients with DTC whose risk had been upgraded after surgery. Methods: We retrospectively reviewed the medical records of 1,702 patients with DTC who underwent TL and ipsilateral central lymph node (LN) dissection between January 2006 and December 2011. The patients were classified into Group A (n=1,159; low risk; ≤5 central LN metastases or the absence of pathologic microscopic capsular invasion) and Group B (n=543; upgraded intermediate risk after surgery;>5 central LN metastases or the presence of pathologic microscopic capsular invasion). We analyzed their clinicopathological characteristics and recurrence-free survival.Results: All 32 patients who experienced recurrence underwent CT. After the first operation, the duration until reoperation in Groups A and B were 8.00±2.74 (range, 3.42-12.17) years and 5.10±3.09 (range, 1.25-11.67) years, respectively. There was no significant difference in recurrence rates, disease-related mortality rates, or 10-year recurrence-free survival rates between the two groups. The mean follow-up durations in Groups A and B were 10.22±1.58 and 10.13±1.47 years, respectively. Univariate analysis showed that sex, age, tumor size, multifocality, extrathyroidal extension (ETE), and number of central LN metastases were not associated with recurrence after TL, although the rate of central LN metastases was. Multivariate analysis showed that sex, age, tumor size, multifocality, ETE, central LN metastases, and the number of central LN metastases were not associated with recurrence after TL, although multifocality was.Conclusions: TL with prophylactic central compartment neck dissection (CCND) is sufficient for patients with DTC whose risk is upgraded after surgery because they have a good prognosis at long-term follow-up.Larger-scale randomized clinical trials are required to confirm our findings.

show abstract

Section: Discussionmentioning

confidence: 49%

Thyroid lobectomy is sufficient for differentiated thyroid cancer with upgraded risk after surgery

Choi¹,

Kim²,

Lee³

et al. 2022

Gland Surg

Self Cite

View full text Add to dashboard Cite

show abstract

“…Te median follow-up is 12.8 ± 4.3 (8.3-30.5) years and 13.4 ± 4.4 (8.3-32.3) years, respectively. According to these results, the authors concluded that the second total thyroidectomy surgery is not necessary in patients with positive CLN metastasis after the pCND [33]. Terefore, when the number of microscopic metastatic lymph nodes >5, patients can choose a second total thyroidectomy or an active surveillance strategy.…”

Section: Discussionmentioning

confidence: 99%

Occult Central Lymph Node Metastasis in cN0 Papillary Thyroid Carcinoma Patients Undergoing TOETVA Procedure

Xuan,

Anh,

Xuan

et al. 2023

Journal of Thyroid Research

View full text Add to dashboard Cite

Background. In this study, we evaluate the rate of CLNM and related factors in patients with cN0 PTC undergoing transoral endoscopic thyroidectomy vestibular approach (TOETVA), a feasible and safe procedure that is widely approved for early stage PTC patients. Method. A cross-sectional study was performed on 346 patients who underwent TOETVA due to thyroid cancer in the Department of Oncology and Palliative Care, Hanoi Medical University Hospital, from January 2020 to December 2021. The clinical, surgical, and pathological characteristics were recorded. Results. The mean age was 36.1 ± 9.1 (13–67) years. Females accounted for 96%. Total thyroidectomy was applied in 55 cases (15.9%), and conservative thyroidectomy accounted for 291 (84.4%). The median number of harvested lymph nodes in ipsilateral and bilateral CND groups is 5 (IQR: 3–7) and 7 (IQR: 3–10). The median number of metastasized lymph nodes in these two groups is 2 (IQR: 1–3) and 3 (IQR: 2–6), respectively. The rate of CLNM was 39.9%. Thyroiditis increased the number of harvested lymph nodes: 8.3 ± 0.7 (1–24) nodes, p = 0.002 . Tumor size on ultrasound, young age (<29 years old), and stage of tumor increased the possibility of CLNM, p < 0.05 . Univariate and multivariate logistic regression revealed that young age (<29 years old) and gross tumor invasion were independent risk factors of high number of CLNM with p < 0.05 . Conclusion. In summary, CLNM rate in patients with cN0 PTC accounted for 39.9%. With the facilities of pCND by TOETVA, a procedure that is widely approved for early PTC and has excellent cosmetics and oncological results, pCND should be considered in patients with risk factors like young age or large tumor. High volume of CLNM is associated with young age and gross tumor extension, and total thyroidectomy should be indicated in these patient groups.

show abstract

“…Papillary thyroid carcinoma (PTC) was the most frequent histological subtype of thyroid malignancy which has a rapidly rising incidence worldwide in the last few decades (1,2). In total, 20.7-62% of patients with PTC present cervical lymph node metastasis (LNM) at initial diagnosis, which was associated with a poor prognosis (3,4), yet the recently updated 8th edition of the TNM staging system eliminates the difference between central (N1a) and lateral (N1b) LNM, and N1b disease is not adopted for the final staging classification (5)(6)(7). These changes have been questioned, and concern arises in such a way that ignoring the metastatic lymph node sites may underestimate recurrence and mortality in patients with PTC.…”

Section: Introductionmentioning

confidence: 99%

Can Cervical Lymph Node Metastasis Increase the Risk of Distant Metastasis in Papillary Thyroid Carcinoma?

et al. 2022

View full text Add to dashboard Cite

BackgroundDistant metastasis (DM) is a rare event and has a negative effect on the prognosis for papillary thyroid carcinoma (PTC). The relationship between cervical lymph node metastasis and DM is complicated and unclear. This study aimed to evaluate the impact of N stage subclassification on different distant metastasis sites based on age stratification, especially for patients with papillary thyroid microcarcinoma.MethodsA total of 28,712 patient with PTC cases between 2010 and 2018 were extracted from the Surveillance, Epidemiology, and End Results database. Multivariable logistic regression analysis was utilized to adjust for confounding variables. Risk stratification, including positive lymph node number and lymph node ratio, was established by receiver operating characteristic curves to help predict DM.ResultsLung was the most common metastatic site regardless of N0, N1a disease, or N1b disease. As the N stage increased, the higher the rate of DM identified. After age stratification, only N1b disease significantly increased the risk of lung metastasis (LM; odds ratio, OR = 20.45, P < 0.001) rather than bone metastasis (BM; OR = 3.46, P > 0.05) in younger patients. However, in older patients, N1b disease significantly increased the risk of both LM (OR = 4.10, P < 0.001) and BM (OR = 2.65, P = 0.007). In patients with papillary thyroid microcarcinoma (PTMC), N1a disease did not increase the risk of DM, LM, and BM compared with N0 disease (P > 0.05). Furthermore, combined N stage with risk stratification has well performance in predicting DM (area under the curve, AUC = 0.761). Similar results were shown in PTC patients with LM (AUC = 0.770) and BM (AUC = 0.729).ConclusionOverall, the incidence of DM significantly increased with the progress of N disease after age stratification. N1a disease did not increase the risk of DM in PTMC patients, regardless of LM or BM. Combined N stage with risk stratification may be beneficial for DM prediction.

show abstract

Completion Total Thyroidectomy Is Not Necessary for Papillary Thyroid Microcarcinoma with Occult Central Lymph Node Metastasis: A Long-Term Serial Follow-Up

Cited by 6 publications

References 70 publications

Thyroid lobectomy is sufficient for differentiated thyroid cancer with upgraded risk after surgery

Thyroid lobectomy is sufficient for differentiated thyroid cancer with upgraded risk after surgery

Occult Central Lymph Node Metastasis in cN0 Papillary Thyroid Carcinoma Patients Undergoing TOETVA Procedure

Can Cervical Lymph Node Metastasis Increase the Risk of Distant Metastasis in Papillary Thyroid Carcinoma?

Contact Info

Product

Resources

About