Risk stratification for lateral involvement in papillary thyroid carcinoma patients with central lymph node metastasis

Heng, Yu; Yang, Zheyu; Zhou, Liang; Lin, Jia Wei; Cai, Wei; Tao, Lei

doi:10.1007/s12020-020-02194-8

Cited by 29 publications

(42 citation statements)

References 30 publications

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“…Besides, ETE was also an independent predictor for ipsi-LLNM, which was consistent with previous studies (32)(33)(34)(35)(36)(37). We considered that the more aggressive the tumor, the greater the probability of LNM.…”

Section: Discussionsupporting

confidence: 91%

Prediction of Ipsilateral Lateral Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma: A Combined Dual-energy CT and Thyroid Functional Indicators Study

Zou

Zhang

et al. 2020

Preprint

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BackgroundThe prediction of ipsilateral lateral cervical lymph node metastasis (ipsi-LLNM) was crucial to the operation plan in patients with papillary thyroid carcinoma (PTC). This study aimed to investigate the risk factors for ipsi-LLNM using dual-energy computed tomography (DECT) and thyroid functional indicators in patients with PTC. MethodsThe medical records of 406 patients with a pathological diagnosis of PTC were retrospectively reviewed from Jan 2016 to Dec 2019. Demographic, clinical, pathological findings, and parameters from DECT were evaluated. Risk factors for ipsi-LLNM were explored by univariate and multivariate analyses. Receiver operating characteristic (ROC) curves were used to evaluate the cut-off value of each risk factor.ResultsTotally 406 patients with PTC were analyzed, including 128 with ipsi-LLNM and 278 without. There were statistical differences of parameters between the two groups (P < .0001), including serum Tg, Anti-Tg, Anti-TPO, the volume of the primary lesion, calcification, extrathyroidal extension (ETE), and iodine concentration (IC) in arterial and venous phases. Independent risk factors for ipsi-LLNM included serum Tg, Anti-Tg, ETE, and IC in arterial and venous phases (P < .05). Ipsi-LLNM was more likely to occur when the following conditions were met: with ETE, Tg > 100.01 ng/ml, Anti-Tg > 89.43 IU/ml, IC in arterial phase > 3.4 mg/ml and IC in venous phase > 3.1 mg/ml.ConclusionsApplication of DECT parameters and thyroid functional indicators can improve the diagnostic performance in the evaluation of ipsi-LLNM in patients with PTC.

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Section: Discussionsupporting

confidence: 91%

Prediction of Ipsilateral Lateral Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma: A Combined Dual-energy CT and Thyroid Functional Indicators Study

Zou

Zhang

et al. 2020

Preprint

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“…We therefore further evaluated the predictive factors for the lateral multiple-metastasis in N1b PTMC. Other studies (4,14,28) have reported that CPLN was a predictor of lateral LNM in PTC patients. Xiao et al (29) conducted ipsilateral LND for PTC patients and demonstrated that CPLN ≥ 2 was a reliable indicator of lateral LNM.…”

Section: Discussionmentioning

confidence: 88%

“…The risk factors for the lateral LNM in PTMC patients have been investigated (12)(13)(14)(15). To the best of our knowledge, though, lateral multiple-level metastasis in N1b PTMC patients has never been previously reported.…”

Section: Introductionmentioning

confidence: 99%

Management of Lateral Multiple-Level Metastasis in N1b Papillary Thyroid Microcarcinoma

et al. 2020

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Background: The optimal extent of therapeutic lateral neck dissection (LND) in the management of N1b papillary thyroid microcarcinoma (PTMC) is still under debate in clinical practice. In this light, our study aims to explore the incidence, patterns, and predictive factors of the lateral multiple-level metastasis in N1b PTMC patients. Methods: The clinical records of 142 patients diagnosed with N1b PTMC who underwent therapeutic LND from July 2015 to November 2018 at our institution were retrospectively reviewed. Univariate and multivariate analyses were conducted to examine the predictive factors associated with lateral multiple-level metastasis. The recurrence-free survival was analyzed and confirmed by Kaplan–Meier plots and log-rank test. Results: The overall frequency of lateral multiple-level metastasis was 50.7% in N1b PTMC patients, and two-level to four-level simultaneous metastasis were present in 26.8, 17.6, and 6.3% patients, respectively. Extrathyroidal extension (ETE) (OR = 5.79, 95% CI, 1.36–24.59; P = 0.017) and the central metastatic lymph node ratio (CLNR) with values equal or higher than 0.61 (OR = 6.18, 95% CI, 2.53–15.09; P < 0.001) served as independent predictors of multiple-level metastasis in N1b PTMC patients. Moreover, locoregional recurrence was significantly higher in the selective neck dissection (SND) group compared to the modified radical neck dissection (MRND) one (HR = 3.65, 95% CI, 1.11–12.00; P = 0.03). Conclusion: Our results show that the lateral multiple-level metastasis was relatively common, and we suggest MRND to be considered for N1b PTMC patients with ETE or CLNR equal or higher than 0.61.

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“…LLNM has been included as a risk factor for structural recurrence in ATA (12)and has even been shown to influence outcome in some reports (23). As an essential risk factor for LLNM, the number of CCLMs is increasingly being included in risk stratification, with typical cutoff values of 2-3 and 5 (18,24,25). We identified number of CLNMs as an independent risk factor for LLNM when patients were stratified into 0, 1-2, and ≥3 CLNM groups.…”

Section: Discussionmentioning

confidence: 93%

Risk Factors and a Prediction Model of Lateral Lymph Node Metastasis in CN0 Papillary Thyroid Carcinoma Patients With 1–2 Central Lymph Node Metastases

et al. 2021

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BackgroundPapillary thyroid cancer (PTC) in clinically lymph node-negative (cN0) patients is prone toward lymph node metastasis. As a risk factor for tumor persistence and local recurrence, lateral lymph node metastasis (LLNM) is related to the number of central lymph node metastases (CLNMs).MethodsWe performed LLNM risk stratification based on the number of CLNMs for cN0 PTC patients who underwent thyroidectomy and lymph node dissection between January 2013 and December 2018. A retrospective analysis was applied to the 274 collected patients with 1-2 CLNMs. We examined the clinicopathological characteristics of the patients and constructed a LASSO model.ResultsIn the 1–2 CLNM group, tumors >10 mm located in the upper region and nodular goiters were independent risk factors for LLNM. Specifically, tumors >20 mm and located in the upper region contributed to metastasis risk at level II. Hashimoto’s thyroiditis reduced this risk (p = 0.045, OR = 0.280). Age ≤ 30 years and calcification (microcalcification within thyroid nodules) correlated with LLNM. The LASSO model divided the population into low- (25.74%) and high-risk (57.25%) groups for LLNM, with an AUC of 0.715.ConclusionsFor patients with 1–2 CLNMs, young age, calcification, nodular goiter, tumor >10 mm, and tumor in the upper region should alert clinicians to considering a higher occult LLNM burden. Close follow-up and therapy adjustment may be warranted for high-risk patients.

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Risk stratification for lateral involvement in papillary thyroid carcinoma patients with central lymph node metastasis

Cited by 29 publications

References 30 publications

Prediction of Ipsilateral Lateral Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma: A Combined Dual-energy CT and Thyroid Functional Indicators Study

Prediction of Ipsilateral Lateral Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma: A Combined Dual-energy CT and Thyroid Functional Indicators Study

Management of Lateral Multiple-Level Metastasis in N1b Papillary Thyroid Microcarcinoma

Risk Factors and a Prediction Model of Lateral Lymph Node Metastasis in CN0 Papillary Thyroid Carcinoma Patients With 1–2 Central Lymph Node Metastases

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