Prognostic Factors Affecting Neck Lymph Node Recurrence and Distant Metastasis in Papillary Microcarcinoma of the Thyroid: Results of a Study in 445 Patients

Mercante, Giuseppe; Frasoldati, Andrea; Pedroni, Corrado; Formisano, Debora; Renna, Luigi; Piana, Simonetta; Gardini, Giorgio; Valcavi, Roberto; Barbieri, Verter

doi:10.1089/thy.2008.0270

Cited by 249 publications

(189 citation statements)

References 47 publications

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“…In our study, 32.6% of PTMC patients was found multifocality, and 45.2% of them had central LNM, which , in univariate analysis, was significantly higher than unifocal (p=0.002). This was similar to the results of prior studies, which reported PTMC multifocality was found in 20% to 40% of PTMC patients, 40% to 70% of whom had LNM (Mercante et al,2009 ;Connor et al, 2011;Dunki-Jacobs et al, 2012). However, in multivariate analysis, there was no significant difference in the rate of CLNM between unifocal and multifocal group (p=0.189).…”

Section: Discussionsupporting

confidence: 90%

Risk Factors for Nodal Metastasis in cN0 Papillary Thyroid Microcarcinoma

Zhang¹,

Liu²,

Liu³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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Section: Discussionsupporting

confidence: 90%

Risk Factors for Nodal Metastasis in cN0 Papillary Thyroid Microcarcinoma

Zhang¹,

Liu²,

Liu³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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“…Patients with PTC have excellent prognosis; however, the presence of LNM significantly increases the risk of locoregional recurrence, and some groups have demonstrated decreased disease‐free survival rate and increased mortality associated with regional LNM 4, 5, 6, 7, 8, 9, 10. Extensive LND has the potential to decrease regional recurrence and increase disease‐free survival, but may lead to clinically important postoperative morbidities 13, 14, 15.…”

Section: Discussionmentioning

confidence: 99%

“…Cervical LNM in PTC have been identified as an independent risk factor for regional recurrence 4, 5, 6, 7, and emerging evidences from large population‐based studies have indicated decreased disease‐free survival rate and increased mortality associated with regional LNM 7, 8, 9, 10. There is universal agreement that therapeutic lateral neck dissection (LND) should be undertaken in patients with PTC and clinically lateral LNM (LLNM) on the basis of palpation or imaging examination 11, 12.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for level V lymph node metastases in solitary papillary thyroid carcinoma with clinically lateral lymph node metastases

et al. 2016

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The extent of lateral neck dissection (LND) in surgical resection of papillary thyroid carcinoma (PTC) with clinically lateral LNM (LLNM) remains controversial. We aimed to explore the frequency of and risk factors for level V LNM in patients with solitary PTC and clinically LLNM. To analyze the frequency and risk factors for level V LNM, we retrospectively reviewed 220 solitary PTC patients who underwent total thyroidectomy, bilateral central neck dissection, and therapeutic LND. LLNM were present in 82.3% patients, and levels II–V LNM were present in 45.9%, 62.7%, 55.5%, and 12.3% patients, respectively. Ipsilateral level V LNM was significantly associated with tumor size >10 mm, extrathyroidal extension, ipsilateral central LNM ratio ≥50%, and contralateral central LNM (CLNM), bilateral CLNM, and simultaneous levels II–IV LNM. Contralateral CLNM was an independent risk factor for level V LNM. In patients with solitary PTC and clinically LLNM, level V LNM was relatively uncommon. Therefore, routine level V lymphadenectomy may be unnecessary in these patients unless level V LNM is suspected on preoperative examination or associated risk factors, especially contralateral CLNM, are present.

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“…13,14 Add to this some would argue that in case of CLN metastases, there would also be metastases at level VII; thus CLND would not be sufficient treatment. 15 This study aimed to compare the outcome of pCLND versus no dissection in case of PTC with N0 neck.…”

Section: Introductionmentioning

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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Prognostic Factors Affecting Neck Lymph Node Recurrence and Distant Metastasis in Papillary Microcarcinoma of the Thyroid: Results of a Study in 445 Patients

Abstract: Total thyroidectomy seems advisable in PMC with extrathyroidal extension and neck lymph node metastasis at presentation. Capsular invasion without extrathyroidal extension may suggest aggressive tumor behavior and require radical treatment.

Cited by 249 publications

References 47 publications

Risk Factors for Nodal Metastasis in cN0 Papillary Thyroid Microcarcinoma

Risk Factors for Nodal Metastasis in cN0 Papillary Thyroid Microcarcinoma

Risk factors for level V lymph node metastases in solitary papillary thyroid carcinoma with clinically lateral lymph node metastases

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

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