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

Yang, Jing; Gong, Yanping; Yan, Shuping; Zhu, Jingqiang; Li, Zhihui; Gong, Renmin

doi:10.1002/cam4.792

Cited by 20 publications

(29 citation statements)

References 30 publications

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“…Central lymph node specimens were classified and mapped in our previous study. [ 18 ] We defined the pretracheal compartment as superior to the lower edge of the isthmus, inferior to the innominate vein, and bilateral to the sidewall of the trachea. For patients with bilateral cN1a, therapeutic bilateral CLND was performed; for patients with cN1b, bilateral CLND and ipsilateral lateral LND were performed.…”

Section: Methodsmentioning

confidence: 99%

Unilateral papillary thyroid carcinoma treated with contralateral central lymph node dissection

Chen

Li²,

Zhu³

et al. 2020

Medicine

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The central lymph nodes of the neck are the most common sites of papillary thyroid carcinoma (PTC) but cannot be easily diagnosed preoperatively. Prophylactic central lymph node dissection (CLND), especially contralateral CLND, is not recommended in various guidelines due to its high risk. The aim of our study was to establish an objective point score based on preoperative and intraoperative data to guide the selection of patients for contralateral CLND. We retrospectively evaluated 1085 consecutive patients with PTC treated by thyroidectomy for inclusion in this study (the training cohort). Variables of contralateral central lymph node macro-metastasis (CLNMM) were investigated using univariate and multivariate analyses; subsequently, nomograms were developed and then validated in an independent cohort of patients (n = 326, the validation cohort). Univariate and multivariate analyses indicated that preoperative fine needle aspiration-proven ipsilateral lateral lymph node metastasis (LNM) (odds ratio [OR] 4.888, 95% confidence interval [CI] 1.587–41.280, P < .001) and cases with frozen-section pretracheal LNM (OR 19.015, 95% CI 2.949–186.040, P < .001) or Delphian LNM (OR 4.494, 95% CI 1.503–54.128, P < .001) were the 3 risk factors for contralateral CLNMM. A receiver operating characteristic curve indicated a cutoff value of 1 for the frozen-section pretracheal LNM number or the Delphian LNM number as a predictor of contralateral central lymph node metastasis (CLNM). The nomogram was then generated according to the 3 risk factors and well validated in the external cohorts, and the intraoperative frozen-section results were highly consistent with the postoperative pathological results. The proposed nomogram based on the 3 factors showed a good prediction of contralateral CLNMM in PTC.

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Section: Methodsmentioning

confidence: 99%

Unilateral papillary thyroid carcinoma treated with contralateral central lymph node dissection

Chen

Li²,

Zhu³

et al. 2020

Medicine

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“…However, lateral neck lymph node metastasis was found in 20–90% of patients with papillary thyroid carcinoma 2 , 3 . An important risk factor for higher recurrence rate and lower survival rate in patients with thyroid cancer is neck lymph node metastasis 4 , 5 , especially for lateral neck lymph node metastasis 6 . Lateral neck lymph node dissection is relatively risky and prone to accidental injury and complications because of the specificity of biological behavior of papillary thyroid carcinoma and the complexity of neck lymph node dissection.…”

Section: Introductionmentioning

confidence: 99%

Establishing a prediction model for lateral neck lymph node metastasis in patients with papillary thyroid carcinoma

Jin

Bao

Yang

et al. 2018

Sci Rep

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This study aimed to establish a model for predicting lateral neck lymph node metastasis in patients with papillary thyroid carcinoma. A total of 106 patients with papillary thyroid carcinoma undergoing initial treatment of neck lymph node dissection (including central and lateral neck lymph nodes) at the thyroid surgery department were enrolled from January 2009 to April 2017. Logistic regression analysis was used to screen the factors influencing lateral neck lymph node metastasis and develop a prediction model. The receiver operating characteristic curve was used to evaluate the predictive power and boundary value of the model for lateral neck lymph node metastasis. Prediction model: Logistic(P) = −5.699 + 0.681 × (TSH) + 0.342 × (Metastatic rate of central lymph nodes) + 1.463 × (Combined with Hashimoto’s disease) + 1.525 × (Number of tumors). When logistic (P) was ≥ 0.821, it was predicted that lateral neck lymph node metastasis occurred in patients with papillary thyroid carcinoma. When logistic (P) was <0.821, it was predicted that no metastasis was found in the lateral neck lymph node. The prediction accuracy was 78.3%. The model helped in evaluating lateral neck lymph node metastasis in patients with papillary thyroid carcinoma. Also, it had significance in determining reasonable surgical range, reducing unnecessary lateral neck lymph node dissection, and further improving the quality of life of patients.

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“…The extent of lateral neck dissection in clinically evident LN metastasis is still under debate ranging from the modified radical neck dissection type 3 (removal of LN in levels II‐V) to even more selective nodal dissections (removal of compartments with clinically evident LN disease). Although the 2012 American Thyroid Association consensus review and statement regarding the anatomy, terminology, and rationale for lateral neck dissection in differentiated thyroid cancer recommend a comprehensive type 3 modified radical neck dissection, subsequent studies have raised question on the necessity of routine level V LN dissection . There is no evidence at the moment that one procedure is better than the other, apart from the “berry‐picking” procedures (removal of the involved LN only), which is associated with higher regional recurrence rate .…”

Section: Introductionmentioning

confidence: 99%

Extent of lateral neck dissection for papillary thyroid microcarcinomas

2018

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Background Papillary thyroid microcarcinomas (PTMCs) often demonstrate lateral lymph node (LN) metastasis. The purpose of this study was to assess whether the size of primary tumor should be considered in deciding lateral neck dissection extent. Methods We conducted a retrospective comparison of patients with PTMC and papillary thyroid carcinoma (PTC) larger than 1 cm who received lateral LN dissection from 2009 to 2015. Results PTMC group had more frequent metachronous metastasis, multifocality, less involvement of lower third thyroid, lower metastatic central LN counts and ratio, and lower metastatic total LN ratio. The two groups showed no difference in lateral LN metastatic pattern. Male and lymphovascular invasion were more often found in PTMCs with synchronous lateral LN metastatic events than metachronous presentations. Conclusions Relying on the size of the tumor to determine lateral neck dissection extent could be unreliable, because there is no observed difference in lateral neck metastatic count and pattern between PTC and PTMCs.

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

Cited by 20 publications

References 30 publications

Unilateral papillary thyroid carcinoma treated with contralateral central lymph node dissection

Unilateral papillary thyroid carcinoma treated with contralateral central lymph node dissection

Establishing a prediction model for lateral neck lymph node metastasis in patients with papillary thyroid carcinoma

Extent of lateral neck dissection for papillary thyroid microcarcinomas

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