Prediction of central compartment lymph node metastasis in papillary thyroid microcarcinoma

Abstract

SummaryObjectives We aimed to determine the predictive factors for central compartment lymph node metastasis (LNM) in papillary thyroid microcarcinoma (PTMC). Design and patients We undertook a retrospective study of 291 patients treated for PTMC. The following criteria were assessed to predict the presence of central compartment LNM: sex, age, tumour multifocality, tumour size, tumour bilaterality, extracapsular spread (ECS), lateral neck LNM, coexistence of chronic lymphocytic thyroiditis, BRAF V600E mutation and ultrasonography (US) features. Univariate and multivariate analyses were performed to identify clinicopathological characteristics and US findings in predicting central compartment LNM from PTMC.Results The central compartment LNM affected 133 (45Á7%) of 291 patients. With use of univariate and multivariate analyses, male gender (OR 2Á020; P = 0Á039), tumour size (>5 mm) (OR 3Á687; P = 0Á015), ESC (OR 2Á330; P = 0Á044), lateral LNM (OR 15Á075; P = 0Á000) and BRAF V600E mutation (OR 2Á464; P = 0Á000) were independently correlated with central compartment LNM. Age, tumour multifocality, tumour bilaterality, coexistence of chronic lymphocytic thyroiditis and US characteristics were not significantly related to the presence of central compartment LNM. We have also developed a nomogram to predict the probability of central compartment LNM for an individual patient. The sensitivity was 71Á9% and specificity was 70Á3%, with an under the receiver operating characteristic (ROC) curve of 0Á772.Conclusions A prophylactic neck dissection of the central compartment should be considered particularly in PTMC patients with male gender, a >5 mm tumour size, ECS of the tumours, lateral LNM and positive BRAF V600E mutation.

Risk Factors for Nodal Metastasis in cN0 Papillary Thyroid Microcarcinoma

“…Yang et al (2014) reported tumoral infiltration of thyroid capsule was found in 12.7% of PTC, 78.4% of whom had LNM. Our study showed ECS was found 11.2% of PTMC, 70% of whom had LNM, which was significantly higher than ECS absent group (p=0.005).…”

“…Although women have been shown to be more susceptible to PTC than men, male gender has previously :http://dx.doi.org/10.7314/APJCP.2015.16.8.3361 Risk Factors for Nodal Metastasis in cN0 Papillary Thyroid Microcarcinoma been suggested as important indicator for LNM in previous reports (Yang et al, 2014). In this study, the CLNM positive rate of males was 59.5%, which, in multivariate analysis, was independently predictive of central compartment LNM (p=0.000).…”

Association of BRAFV600E Mutation and MicroRNA Expression with Central Lymph Node Metastases in Papillary Thyroid Cancer: A Prospective Study from Four Endocrine Surgery Centers

“…The tall-cell variant of PTC (TCVPTC) has the highest prevalence at 93% (15), followed by classical variant of PTC (CVPTC), comprising up to 75.3% (11), and lastly, follicular variant of PTC (FVPTC) at only 25% (16). Some studies have shown that the BRAF V600E mutation is associated with aggressive clinicopathologic features, such as extrathyroidal invasion, multifocality, lymphovascular invasion, large tumor size, local lymph node metastasis, distant metastasis, and advanced disease stages (17)(18)(19)(20)(21)(22), whereas others studies have demonstrated no association between the BRAF V600E mutation and aggressive features (23)(24)(25)(26)(27)(28)(29)(30). In a previous retrospective study, the BRAF V600E mutation was found to be an independent predictor of CLNM in the overall cohort of patients with PTC (23).…”

“…However, this relationship lost significance when only CVPTC was included in the analysis (23). Despite the discrepancies that exist in the literature, some studies have suggested the incorporation of BRAF V600E mutation into the management algorithm of PTC to improve perioperative decision making (9,17,18,20,22). However, the usefulness of BRAF V600E in predicting the presence of LNM remains questionable (23,31).…”

Predictive Factors for Central Neck Lymph Node Metastasis in Patients with Papillary Thyroid Microcarcinoma without Suspicious Metastasis by Preoperative Ultrasonography

“…Despite relatively good prognosis, with slow progression and high survival rate, several studies have reported recurrences and metastases in PTMCs (5), the most common of which is metastasis to the central lymph node of cervical neck (6,7). Given that central neck lymph node metastasis (CLNM) is the most significant risk factor in predicting locoregional recurrences (4,8,9), therapeutic central neck dissection is necessary if CLNM is detected in preoperative examination (10).…”