Micrometastases in thyroid cancer. An important finding?

Cranshaw, Isaac; Carnaille, B.

doi:10.1016/j.suronc.2008.04.005

Cited by 127 publications

(90 citation statements)

References 34 publications

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“…Several studies have shown that patients with N1 disease have variable outcomes. Indeed, the presence of palpable LNM (7), a higher number of metastatic nodes, large metastatic nodes, and extranodal extension have been shown to correlate with poorer outcome (8)(9)(10). Although the histopathologic and clinical analysis were detailed in some of these *These three authors are co-first authors.…”

Section: Introductionmentioning

confidence: 99%

Papillary Thyroid Carcinomas with Cervical Lymph Node Metastases Can Be Stratified into Clinically Relevant Prognostic Categories Using Oncogenic BRAF, the Number of Nodal Metastases, and Extra-Nodal Extension

Ricarte-Filho

Ganly

Rivera

et al. 2012

Thyroid

107

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Background: Papillary thyroid carcinoma (PTC) patients presenting with cervical lymph nodes (LN) metastases (M) have a variable outcome. The objective of this study is to assess the value of meticulous histopathologic examination and genotyping in stratifying these patients into clinically relevant prognostic subgroups. Methods: This was a retrospective clinical and histopathological review of PTC patients with lymph node metastases at presentation identified between 1980 and 2002 in a single institution. Primary tumors from patients who later recurred were matched to a group of patients who did not recur and subjected to mass spectrometry genotyping encompassing the most significant oncogenes in thyroid carcinomas. Results: There were 246 patients who satisfied the inclusion criteria. The median follow-up was 10.8 years. The presence of > 3 metastatic nodes was an independent predictor of decreased recurrence free survival ( p = 0.03). In patients < 45 years, none of 45 with 1-2 metastatic LN recurred, including 26 patients followed for a median of 13 years without radioactive iodine (RAI) therapy. BRAF mutations were found in 28 (78%) of 36 genotyped tumors. Combined positivity for BRAF and extra-nodal extension was much stronger in predicting disease specific survival (DSS) ( p = 0.004) than the single analysis of BRAF ( p = 0.12) or extra-nodal extension ( p = 0.02). Conclusions: (i) The number of metastatic LN is an independent predictor of recurrence in all age groups and identifies a subset of young patients with excellent prognosis who may not benefit from RAI therapy.(ii) Combined positivity for BRAF and extra-nodal extension has additive prognostic value in predicting DSS. (iii) Classification systems that assign the same magnitude of risk for recurrence or death to all patients with N1 disease should be revisited.

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Section: Introductionmentioning

confidence: 99%

Papillary Thyroid Carcinomas with Cervical Lymph Node Metastases Can Be Stratified into Clinically Relevant Prognostic Categories Using Oncogenic BRAF, the Number of Nodal Metastases, and Extra-Nodal Extension

Ricarte-Filho

Ganly

Rivera

et al. 2012

Thyroid

107

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“…The carcinogenic potential of these microscopic node metastases was previously studied and evaluated. The majority of studies suggested that microscopic lymph node metastasis had a minimal clinical impact, particularly in terms of loco-regional recurrences [12][13][14].…”

Section: Histological Resultsmentioning

confidence: 99%

Oncologic Results of Completion Thyroidectomy and Secondary Prophylactic Lymph Node Dissection in the Management of Differentiated Thyroid Cancer

-Hennekine¹

2012

Thyroid Disorders Ther

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“…Some authors have reported that each lobe of the thyroid gland has its own internal lymphatic system, and there is no communication with contralateral regional lymph nodes 14,15) (although PTC can spread to regional lymph nodes bilaterally [16][17][18] ) It has been generally accepted that lymphatic drainage occurs from the thyroid primarily to the central lymphatic compartment and secondarily to the lateral compartment nodes. 19,20) As a result, locoregional spread of thyroid cancer predominantly involves the ipsilateral, and sometimes also the contralateral central and lateral neck nodes.…”

Section: Lymphatic Drainage Of the Thyroidmentioning

confidence: 99%

Regional Lymph Node Metastasis in Papillary Thyroid Cancer

Park

Lee

Bae

et al. 2014

J Korean Thyroid Assoc

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Papillary thyroid cancer is a common endocrine cancer and commonly presents with lymph node metastases. It has been generally accepted that lymphatic drainage occurs from the thyroid primarily to the central lymphatic compartment and secondarily to the lateral compartment nodes. Recently, improvements in the resolution of imaging studies and the availability of highly sensitive thyroglobulin assays have highlighted the importance of identifying disease in the pre-operative assessment and dealing effectively with metastatic regional disease in order to prevent recurrence. However, there are limitations to diagnosing central lymph node metastases. With unreliable imaging modalities, prophylactic central lymph node dissection should be performed on all patients with papillary thyroid cancer. In comparison with the central compartment, prophylactic lateral node dissection has little or no effect on improving the prognosis of patients with papillary thyroid cancer. Therefore, lateral node dissection is recommended only as a part of the therapeutic procedure. The extension of lateral neck dissection is recommended a comprehensive selective neck dissection of levels IIa, III, IV, and Vb. The rich lymphatic supply of the thyroid gland coupled with the propensity for nodal metastases in papillary thyroid cancer require the modern thyroid surgeon to be familiar with the indications for and techniques of regional lymph node dissection.

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Micrometastases in thyroid cancer. An important finding?

Cited by 127 publications

References 34 publications

Papillary Thyroid Carcinomas with Cervical Lymph Node Metastases Can Be Stratified into Clinically Relevant Prognostic Categories Using Oncogenic BRAF, the Number of Nodal Metastases, and Extra-Nodal Extension

Papillary Thyroid Carcinomas with Cervical Lymph Node Metastases Can Be Stratified into Clinically Relevant Prognostic Categories Using Oncogenic BRAF, the Number of Nodal Metastases, and Extra-Nodal Extension

Oncologic Results of Completion Thyroidectomy and Secondary Prophylactic Lymph Node Dissection in the Management of Differentiated Thyroid Cancer

Regional Lymph Node Metastasis in Papillary Thyroid Cancer

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