Predictive factors of central lymph node metastasis in papillary thyroid carcinoma

Ahn, Byong Hyon; Kim, Je Ryong; Jeong, Hyun‐Jun; Lee, Jinsun; Chang, Euijin; Kim, Yong Hun

doi:10.4174/astr.2015.88.2.63

Cited by 49 publications

(38 citation statements)

References 30 publications

(39 reference statements)

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“…Neck lymph node metastasis at diagnosis was reported in nearly 90% of pediatric cases, while they were detected in 35% of adults (Zimmerman et al 1988). Other series reported lymph node involvement at diagnosis in 40-90% of pediatric cases (Newman et al 1998, Landau et al 2000, Dinauer et al 2008, Lazar et al 2009, O'Gorman et al 2010), compared to 20-50% of adults (Zaydfudim et al 2008, Ahn et al 2015 (Table 1).…”

Section: Clinical Presentationmentioning

confidence: 94%

Are we really at the dawn of understanding sporadic pediatric thyroid carcinoma?

Cordioli¹,

Moraes²,

Cury³

et al. 2015

Endocrine-Related Cancer

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Data from the National Cancer Institute and from the literature have disclosed an increasing incidence of thyroid cancer in children, adolescents and adults. Although children and adolescents with thyroid cancer tend to present with more advanced disease than adults, their overall survival rate is excellent; however, there is no clear explanation for the differences observed in the clinicopathological outcomes in these age groups. There has been an ongoing debate regarding whether the clinicopathological differences may be due to the existence of distinct genetic alterations. Efforts have been made to identify these acquired genetic abnormalities that will determine the tumor's biological behavior and ultimately allow molecular prognostication. However, most of the studies have been performed in radiation-exposed pediatric thyroid carcinoma. Therefore, our understanding of the role of these driver mutations in sporadic pediatric differentiated thyroid cancer development is far from complete, and additionally, there is a strong need for studies in both children and adolescents. The aim of this review is to present an extensive literature review with emphasis on the molecular differences between pediatric sporadic and radiation-exposed differentiated thyroid carcinomas and adult population. Key Words" sporadic pediatric papillary thyroid carcinomas " radiation-exposed papillary thyroid carcinomas " RET/PTC

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Section: Clinical Presentationmentioning

confidence: 94%

Are we really at the dawn of understanding sporadic pediatric thyroid carcinoma?

Cordioli¹,

Moraes²,

Cury³

et al. 2015

Endocrine-Related Cancer

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“…28 This difference was statistically significant (P=0.000) which in line with other studies. 29 Author concluded that ages <45 years was significantly associated with increased incidence of CLN metastasis of patients with N0 PTC.…”

Section: Discussionmentioning

confidence: 99%

Papillary thyroid carcinoma, evaluation of prophylactic central compartment’s dissection versus conservative management: a prospective study

Ali

Abdelhameed

2018

Int Surg J

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INTRODUCTIONPTC is the most common well differentiated thyroid carcinoma (WDTC) and is considered a relatively indolent tumor.1 This relatively benign Behavior has led to a concept that CLND would not affect survival rates.2 Despite this, regional lymph node (LN) metastases are frequent in PTC occurring in 20% to 90% of patients. 3The pattern of LN metastasis takes place in a sequential manner; involving the central compartment (level VI) first with a frequency reaching 90% including micrometastases, followed by the ipsilateral lateral compartment and then the contralateral lateral compartment and the mediastinal LN. 4,5 Although there is consensus of block node dissection in node positive patients there is controversy about the benefits of elective CLND in N0 PTC. 6 Patients have a ABSTRACTBackground: Papillary thyroid carcinoma (PTC) is one of the commonest thyroid cancers. While there is consensus of block node dissection in nodal positive patients, there is controversy in dealing with nodal negative patients regarding the need of block node dissection. We aimed to evaluate prophylactic central lymph node dissection (pCLND) versus conservative management in PTC with N0 neck. Methods:This was a prospective randomized study conducted at General Surgery Department, Sohag University Hospital, from August 2013 to September 2017. It included fifty-five patients diagnosed to have PTC with N0 neck randomly divided into two groups; (Group A) included 25 patients who underwent total thyroidectomy (TT) alone and (Group B) included 30 patients who underwent TT with pCLND. We compared both groups regarding the operative and post-operative outcomes.Results: There was temporary hypoparathyroidism with an incidence of 12% for Group A and 23% for Group B (P=0.01). Permanent hypocalcemia occurred in 1 patient in each group (P=0.75). Unilateral recurrent laryngeal nerve (RLN) temporary palsy occurred in 10% for Group B patients and in 8% for Group A patients, (P=0.46). Node metastases were observed in 43% in group B upstaging the disease. Both univariate and multivariate analyses showed that CLN metastasis was significantly associated with age <45, male gender, tumor size >2.0cm, bilaterality, and multifocality. Locoregional recurrence was observed in 4% of patients in group A and in 0% in B.Conclusions: TT+pCLND is a safe treatment in patients with N0 PTC and it can be done without a high complication rate and without recurrence compared to TT without CLND.

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“…The number of lymph nodes resected depends on a number of factors, including the unique lymph node anatomy of the patient, and the skill and experience of the surgeon. Current data conflict regarding the impact of prophylactic central lymph node dissection on surgical morbidity, disease recurrence, and RAI use [2, 5–7, 14, 20, 22–27]. Long-term postoperative thyroglobulin levels appear similar for patients who undergo total thyroidectomy alone as compared to patients who additionally undergo prophylactic central lymph node dissection [6, 13].…”

Section: Discussionmentioning

confidence: 99%

Knowledge of pathologically versus clinically negative lymph nodes is associated with reduced use of radioactive iodine post-thyroidectomy for low-risk papillary thyroid cancer

et al. 2015

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Cervical lymph node metastases are common in papillary thyroid cancer (PTC). Clinically negative lymph nodes confer uncertainty about true lymph node status, potentially prompting empiric postoperative radioactive iodine (RAI) administration even in low-risk patients. We examined the association of clinically (cN0) versus pathologically negative (pN0) lymph nodes with utilization of RAI for low-risk PTC. Using the National Cancer Database 1998–2011, adults with PTC who underwent total thyroidectomy for Stage I/II tumors 1–4 cm were evaluated for receipt of RAI based on cN0 versus pN0 status. Cut-point analysis was conducted to determine the number of pN0 nodes associated with the greatest decrease in the odds of receipt of RAI. Survival models and multivariate analyses predicting RAI use were conducted separately for all patients and patients <45 years. 64,980 patients met study criteria; 39,778 (61.2 %) were cN0 versus 25,202 (38.8 %) pN0. Patients with pN0 nodes were more likely to have negative surgical margins and multifocal disease (all p < 0.001). The mean negative nodes reported in surgical pathology specimens was 4; ≥5 pathologically negative lymph nodes provided the best cut-point associated with reduced RAI administration (OR 0.91, CI 0.85–0.97). After multivariable adjustment, pN0 patients with ≥5 nodes examined were less likely to receive RAI compared to cN0 patients across all ages (OR 0.89, p < 0.001) and for patients aged <45 years (0R 0.86, p = 0.001). Patients with <5 pN0 nodes did not differ in RAI use compared to cN0 controls. Unadjusted survival was improved for pN0 versus cN0 patients across all ages (p < 0.001), but not for patients<45 years (p = 0.11); adjusted survival for all ages did not differ (p = 0.13). Pathological confirmation of negative lymph nodes in patients with PTC appears to influence the decision to administer postoperative RAI if ≥5 negative lymph nodes are removed. It is possible that fewer excised lymph nodes may be viewed by clinicians as incidentally resected and thus may suboptimally represent the true nodal status of the central neck. Further research is warranted to determine if there is an optimal number of lymph nodes that should be resected to standardize pathological diagnosis.

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Predictive factors of central lymph node metastasis in papillary thyroid carcinoma

Cited by 49 publications

References 30 publications

Are we really at the dawn of understanding sporadic pediatric thyroid carcinoma?

Are we really at the dawn of understanding sporadic pediatric thyroid carcinoma?

Papillary thyroid carcinoma, evaluation of prophylactic central compartment’s dissection versus conservative management: a prospective study

Knowledge of pathologically versus clinically negative lymph nodes is associated with reduced use of radioactive iodine post-thyroidectomy for low-risk papillary thyroid cancer

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