Patterns and clinical significance of cervical lymph node metastasis in papillary thyroid cancer patients with Delphian lymph node metastasis

Zheng, Guibin; Zhang, Hua; Hao, Shaolong; Liu, Chengxin; Xu, Jianrong; Ning, Jinyao; Wu, Guoqing; Jiang, Lixin; Li, Guojun; Zheng, Haitao; Song, Xuejiao

doi:10.18632/oncotarget.19047

Cited by 34 publications

(57 citation statements)

References 41 publications

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“…After searching the three databases, 112 studies were included in the meta‐analysis and 29 were removed because of duplication; 58 studies were excluded after carefully scanning the titles and abstracts, which left 25 qualified full‐text articles for evaluation. After scrutinizing the remaining articles, a total of 10 studies with 1582 PTC patients matching the inclusion criteria were considered eligible for the final analysis (Figure ) . The basic characteristics of the studies included in this meta‐analysis are summarized in Table .…”

Section: Resultsmentioning

confidence: 99%

“…If the DLN is confirmed positive by pathological findings intraoperatively, we should perform a complete CLND on the lesion side and evaluate the LLN compartment again. Zheng et al found that the incidence of contralateral paratracheal LNM in DLN‐positive patients was higher (but not significantly) than that in DLN‐negative patients (50% vs 27%), so they recommended that contralateral CLND be considered in DLN‐positive patients with an intermediate or high risk of recurrence. Kim et al found that DLN metastasis was significantly associated with lymphovascular invasion, more than CLNM and LLNM were in DLN‐negative patients, so they suggested that bilateral central neck lymph node dissection is the most appropriate treatment choice for patients with DLN metastasis.…”

Section: Discussionmentioning

confidence: 99%

“…However, the relationship between DLN and other cervical lymph node metastases in PTC remains controversial. Some studies have concluded that a positive DLN can predict CLN metastasis (CLNM) and LLN metastasis (LLNM), while other investigators contend that DLN positivity is not associated with extensive lymph node metastasis and even regard it as a misleading sign . Therefore, we performed a meta‐analysis to investigate the value of DLN metastasis (DLNM) as a predictor of the involvement of the central and lateral compartments in PTC.…”

Section: Introductionmentioning

confidence: 99%

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Use of Delphian lymph node metastasis to predict central and lateral involvement in papillary thyroid carcinoma: A systematic review and meta‐analysis

Huang

Sun

Zhang

et al. 2019

Clinical Endocrinology

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Objective: Whether Delphian lymph node (DLN) metastasis is a reliable predictor of widespread lymph node metastasis in papillary thyroid carcinoma (PTC) remains controversial. This meta-analysis investigated the value of DLN metastasis for predicting central and lateral involvement in PTC. Design and Methods:A literature search using the PubMed, SCIE and the Chinese National Knowledge Infrastructure (CNKI) databases was conducted. Two reviewers independently extracted data and evaluated the studies for inclusion. Fixed-effects and random-effects models were used to analyse the data based on their heterogeneity. A sensitivity analysis was performed, and publication bias was assessed using Begg's funnel plot and Egger's linear regression test. Results: Data from 10 studies were analysed. The risk of central lymph node (CLN) metastasis was significantly higher in the DLN-positive group than in the DLN-negative group (OR = 9.05, 95% CI: 5.13-15.99) with moderate heterogeneity (P = 0.022, I 2 = 53.5%). The risk of lateral lymph node (LLN) metastasis was significantly higher in the DLN-positive group than in the negative group (OR = 10.88, 95% CI: 7.60-15.58), with low heterogeneity (P = 0.603, I 2 = 0.0%). Sensitivity analysis indicated that the results were stable and credible, and no publication bias was found. Conclusions: Delphian lymph node metastasis is valuable for predicting central and lateral compartment involvement in patients with PTC. The DLN of PTC patients should be dissected intraoperatively and sent for frozen section consultation. If the result is positive, the CLNs should be thoroughly dissected and the LLNs should be further evaluated. K E Y W O R D S lymph nodes, lymphatic metastasis, meta-analysis, papillary thyroid cancer, thyroid neoplasms 1 | INTRODUC TI ON Thyroid carcinoma, the most prevalent endocrine malignancy, accounts for 3% of all malignant neoplasms and has risen to become the fifth most prevalent malignant tumour in women. 1 Although China's 5-year survival rate of thyroid carcinoma (84.3%) has improved dramatically in recent years, there is still an obvious gap compared with developed countries in Europe and America. 2 Papillary thyroid carcinoma (PTC) is the most common histopathologic subtype, accounting for 80-90% of all thyroid carcinomas. 3 Cervical

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Use of Delphian lymph node metastasis to predict central and lateral involvement in papillary thyroid carcinoma: A systematic review and meta‐analysis

Huang

Sun

Zhang

et al. 2019

Clinical Endocrinology

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“…First, this is a cross-sectional study without followup, which makes it impossible to determine whether DLN is a direct prognostic factor for unilateral PTC patients. [17][18][19][20][21][22][23]. The rst published study evaluating the associations between DLN metastasis and prognosis of thyroid cancer found that DLN metastasis was signi cantly associated with larger tumor size and was highly predictive of metastasis in other lymph nodes [17].…”

Section: Discusssionmentioning

confidence: 99%

“…The status of DLN metastasis has been shown to be important in deciding the extent of operation, estimating prognosis after the operation and planning radiotherapy [16]. However, there is no consensus on the value of DLN metastasis in the management of thyroid cancer and the number of studies evaluating the role of DLN metastasis in the prognosis of unilateral PTC is still very limited [17][18][19][20][21][22][23]. Therefore, the present study was designed to determine whether DLN metastasis is associated with any prognostic factors of unilateral PTC.…”

Section: Introductionmentioning

confidence: 99%

Incidence and Clinical Significance of Delphian Lymph Node Metastasis in Unilateral Papillary Thyroid Carcinoma

Liu¹,

Wang²,

Ai³

2020

Preprint

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Background: Some studies have reported that Delphian lymph node (DLN) metastasis is associated with a poor prognosis of papillary thyroid carcinoma (PTC), but the number of the available studies is limited and the results are inconsistent. The aim of this investigation was to study the incidence and clinical significance of DLN metastasis in patients with unilateral PTC.Methods: This was a cross-sectional study from January 2016 to December 2019. The data were obtained from the department of general surgery in Shanghai Zhongshan Hospital affiliated to Fudan University. This study included 522 patients with unilateral PTC and had DLN harvested. The associations between DLN metastasis and the clinical characteristics of the patients, i.e. age, sex, tumor size, multifocality, capsular invasion, extrathyroidal extension, central lymph nodes (CLN) metastasis (excluding DLN), and lateral lymph nodes (LLN) metastasis was analyzed.Results: Among all the 522 patients, 133 (25.5%) patients had metastasized DLN lymph nodes. DLN metastasis was significantly associated with age (p = 0.047), male (p < 0.001), larger tumor size (p < 0.001), capsular invasion (p < 0.001), extrathyroidal extension (p = 0.004), tumor location in upper third (p = 0.003), other CLN metastasis (p < 0.001), number of positive CLN (excluding DLN) (p < 0.001), LLN metastasis (p = 0.036), number of positive LLN (p = 0.004) and number of DLN removed (p = 0.043). No association was found between DLN metastasis and multifocality, number of CLN removed and number of LLN removed.Conclusions: DLN metastasis is associated with some adverse prognostic markers of PTC. If the DLN is positive on intraoperative frozen section, careful dissection of CLN and careful evaluation of LLN are essential, and intensive follow-up should be warranted.

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Delphian lymph node metastasis is a novel indicator of tumor aggressiveness and poor prognosis in papillary thyroid cancer

Zhu

Lin

Yan

et al. 2021

Journal of Surgical Oncology

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Background and Objectives: Although the significance of Delphian lymph nodes (DLNs) in patients with papillary thyroid carcinoma (PTC) has been reported, all studies have been based on a small sample size and lack a direct statement concerning prognosis.Methods: A total of 904 consecutive patients were enrolled in the current study, and all patients were divided into two groups (DLN-positive and DLN-negative) according to the presence of DLN metastasis.Results: DLN was detected in 687 patients (76.0%), and 123 (17.9%) had DLN metastasis. Compared to those in the DLN-negative group, the proportion of other central lymph node (CLN) metastases, mean number of metastatic CLNs, and mean metastatic CLN ratio were higher in the DLN-positive group (86.2 vs. 50.2%, 6.70 ± 5.19 vs. 1.60 ± 2.37, and 0.54 ± 0.25 vs. 0.18 ± 0.26, respectively; p < .001).The same phenomena were observed in the metastatic lateral lymph nodes (LLNs) between the DLN-positive and DLN-negative groups (52.0 vs. 15.4%, 7.28 ± 6.08 vs.3.38 ± 3.73, and 0.23 ± 0.15 vs. 0.13 ± 0.12, respectively; p < .001). Patients in the DLN-positive group had shorter LLN metastasis-free survival and distant metastasis-free survival than patients in the DLN-negative group (93.5% vs. 98.6% and 95.9% vs. 98.8%, respectively, p < .05).

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Patterns and clinical significance of cervical lymph node metastasis in papillary thyroid cancer patients with Delphian lymph node metastasis

Cited by 34 publications

References 41 publications

Use of Delphian lymph node metastasis to predict central and lateral involvement in papillary thyroid carcinoma: A systematic review and meta‐analysis

Use of Delphian lymph node metastasis to predict central and lateral involvement in papillary thyroid carcinoma: A systematic review and meta‐analysis

Incidence and Clinical Significance of Delphian Lymph Node Metastasis in Unilateral Papillary Thyroid Carcinoma

Delphian lymph node metastasis is a novel indicator of tumor aggressiveness and poor prognosis in papillary thyroid cancer

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