Papillary thyroid carcinoma: Occurrence and types of lymph node metastases

Abstract

Fifty-seven (35.6%) of 160 patients with papillary thyroid carcinoma had lymph node metastases at the primary treatment. Children and adolescents were most frequently affected (69.2%), followed by the age group of 21-40-year olds (38.8%). Those older than 40 had the lowest incidence of lymph node metastases (29.6%; p less than 0.05). One fifth of all patients had lymph node metastases as first indication of papillary thyroid carcinoma. Two thirds of these patients were 40 years old or younger. Lymph node involvement affected the jugular vein in nearly all cases (78.8%) and the upper mediastinum as well in just under 15%. Women predominated (67.5 vs. 35.3%; p less than 0.05) if there was intrathyroidal tumor growth with lymph node metastases which occurred most frequently in the age group of 21-40-year olds. On the other hand, men had the highest incidence (67.7 vs. 32.5%; p less than 0.05) of lymph node metastases in connection with tumor growth outside the organ. Fixed lymph node metastases occurred more often in men, particularly in those older than 40 years of age. A pT4 stage (tumor growth outside the organ, 66.7%) was often present at the same time. Especially young patients had a high incidence of lymph node metastases in connection with multifocal intrathyroidal tumor growth, the lymph node metastases often being substantially larger than the mostly occult foci of thyroid carcinomas. Cystic degenerations were occasionally mistaken for cervical cysts.

Prognosis and growth activity depend on patient age in clinical and subclinical papillary thyroid carcinoma [Review]

“…Sugino et al evaluated the cases of 746 patients with "nonadvanced PTC" and reported that lymph node metastasis was more frequently observed in patients < 30 yrs [23]. Ahuja et al showed that lymph node metastases were more frequently positive in patients ≤ 40 yrs [24]. We observed that clinical node metastasis detectable on preoperative imaging studies (N) was positive in 41% of patients < 20 yrs [25].…”

Localization of Cervical Node Metastasis of Papillary Thyroid Carcinoma

“…Supraclavicular lymph nodes are involved in 10% to 52% of Nϩ patients [8,9] (36.1% ipsilateral and 6.9% contralateral in our series). It was the third site involved.…”

“…The central nodes were involved in around 90% of patients with positive nodes [1,6,8] (84.7% in our series). The frequency of lateral node involvement among patients with positive nodes ranged from 51% to 100% [1,[7][8][9] (78% in our series). In Nϩ patients central involvement was not systematic, as 15.3% of our Nϩ patients, 8.9% of those of Ozaki et al [6], and 10% of those of Frankenthaler et al [8] showed no involvement of paratracheal nodes.…”

Shorter Distance Between the Nodule and Capsule has Greater Risk of Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma

“…Of these patients, 56.8% (46/81) of men and 41.2% (178/432) of women as well as 54.3% (150/276) of those patients younger than 45yrs and 31.2% (74/237) of those older than 45yrs that were observed with CLNM. Numerous authors have also noted that younger patients are more likely to have CLNM than older subjects (Ahuja et al, 1991;Tisell et al, 1996;Lombardi et al, 2010;Vriens et al, 2011). Other authors suggest that the male gender has a tendency towards node metastasis (Besic et al, 2009;So et al, 2010).…”