Predictive factors affecting the development of central lymph node metastasis in papillary thyroid cancer

Abstract

Objectives The most common subtype of thyroid cancer is papillary thyroid cancer (PTC); lymph node metastases are common in this disease. Factors affecting the development of central lymph metastasis of PTC determine the treatment modality and prognosis of the disease. In this study, we aimed to evaluate the clinicopathologic features affecting the development of central lymph node metastasis. Methods The data of a total of 346 PTC patients who were operated between May 2012 and September 2020 in our clinic and whose follow-up could be reached were evaluated retrospectively. Demographic data, surgical treatment modalities, and histopathological data of all patients were evaluated as a result of at least 6 months of follow-up. Patients age, sex, body mass index, pre-operative TSH levels, anti-TPO, and anti-Tg values at the time of diagnosis, whether lymph node dissection is performed, presence of lymph node metastasis, presence of distant metastasis, stage at the time of diagnosis (TNM 8th edition), ATA risk group at the time of diagnosis, multifocal and/or multicentric (bilaterality), largest tumor size, aggressive histological subtype, lymphovascular invasion of the tumor, extrathyroidal invasion, presence of lymphocytic thyroiditis, and surgical margin positivity were evaluated retrospectively. Results In the development of PTC central metastasis, distant metastasis, tumor size, multifocality, multicentricity, presence of lymphovascular invasion, aggressive tumor subtype, presence of lateral metastasis, nodular goiter, and extrathyroidal spread were found to be effective. Among these factors, T stage, presence of lymphovascular invasion, and multicentricity were identified as independent risk factors for the development of central metastasis. Conclusion Today, the investigation of predictive factors for the development of nodal metastasis in PTC does not seem to be out of date anytime soon. In our study, T stage, presence of lymphovascular invasion, and multicentricity were identified as independent risk factors for the development of central metastasis from the histopathological features of the tumor in PTC and of these features, T stage and multicentricity can be predicted by pre-operative imaging in many patients and can be used to decide whether to perform prophylactic SLN dissection in patients. However, new studies are still needed on this issue, in the literature.

Differentiated Thyroid Cancer in Children and Adolescents: Clinicopathological Characteristics of 32 Patients Followed up in our Pediatric Endocrinology Unit

“…Previous studies had found that tumor size was a risk factor for nodal metastasis, as well as ETE and multicentric disease. [ 28 - 30 ] Caliskan et al [ 31 ] found that tumor stage, presence of lymphovascular invasion, and multicentricity were independent risk factors for the development of central lymph node metastasis in adult populations. We did not find a difference in tumor sizes between the patients with and without nodal metastasis.…”

Early Dynamic Risk Stratification Decreases Rate of Ablative and Adjuvant Radioiodine Use in ATA Low and Intermediate Risk Papillary Thyroid Cancer Patients

“…It has been shown that multicentricity, lymphovascular invasion (LVI), and tumor stage are independent risk factors for determining the possibility of central lymph node metastasis. [ 7 ] We have reported 38% lymph node metastases in central lymph nodes in pT1N0 patients previously. [ 8 ] The impact of CLND on the prognosis of PTC is unclear.…”