1
|
Chen Y, Wang Y, Li C, Zhang X, Fu Y. Meta-analysis of the effect and clinical significance of Delphian lymph node metastasis in papillary thyroid cancer. Front Endocrinol (Lausanne) 2024; 14:1295548. [PMID: 38313842 PMCID: PMC10836594 DOI: 10.3389/fendo.2023.1295548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/18/2023] [Indexed: 02/06/2024] Open
Abstract
Objective To investigate the effect and clinical significance of Delphian lymph nodes (DLN) on the factors influencing papillary thyroid cancer (PTC) to provide individualized guidance for the surgical treatment of thyroid cancer. Methods Relevant studies from PubMed, Web of Science, the Cochrane Library, Embase, and China National Knowledge Infrastructure databases were searched until February 13, 2023. Stringent selection parameters were used to obtain included data and homogeneous articles. Analyses were performed using Revman 5.4 and SPSS software. A P-value of < 0.05 was considered statistically significant. Results Five studies were finally included in this study. The results revealed a higher risk of DLN metastasis (DLNM) in patients with tumor size >1cm, multifocality, and extrathyroidal extension (ETE) of the thyroid. The risk of central lymph node metastasis (CLNM) was 11.25 times higher in DLN-positive patients with PTC than in DLN-negative (OR = 11.25, 95% CI: 8.64-14.64, P < 0.05) patients. The risk of LLNM was 5.57 times higher in DLN-positive patients with PTC than in DLN-negative (OR = 5.57, 95% CI: 4.57-6.78, P < 0.001) patients. The risk of postoperative recurrence in DLN-positive patients with PTC was 3.49 times higher (OR = 3.49, 95% CI: 1.91-6.38, P < 0.001) than in DLN-negative patients with PTC. Conclusion Patients with tumor size >1 cm in diameter, multifocality, and ETE have an increased risk for DLN development. DLN-positive patients with central and lateral cervical lymph node metastasis and postoperative recurrence are at higher risk than DLN-negative patients.
Collapse
Affiliation(s)
| | | | | | | | - Yantao Fu
- Division of thyroid Surgery, China-Japan Union Hospital Of Jilin University, Jilin University, Changchun, China
| |
Collapse
|
2
|
Bradley PJ. Peristomal recurrence following primary total laryngectomy: the enigma of the central compartment neck lymph nodes. Curr Opin Otolaryngol Head Neck Surg 2023; 31:94-104. [PMID: 36730566 DOI: 10.1097/moo.0000000000000854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW The practice of primary total laryngectomy (TL) for advanced laryngo-hypopharyngeal cancer has significantly declined in the developed countries. The treatment options most frequently adopted have changed from open surgery to transoral laser or robotic approaches or nonsurgical (bio-chemo-) radiotherapy. Primary TL remains the treatment of choice in the developing world where healthcare resources are limited, especially for the treatment of cancer. RECENT FINDINGS Peristomal recurrence (PSR) is quite a serious complication, with an incidence of 6.6% from the published literature (mainly concerning the developed world), most diagnosed within 2 years, and associated with >80% mortality. The major risk factors include pretreatment tracheostomy, specific primary tumor subsites, positive surgical margins, and presence of nodal metastasis. The treatment options are limited and most success has been observed with surgery, especially when PSR is diagnosed at an early-stage, which is uncommon. Treatment of advanced-stage disease is usually palliative. Reduction and/or prevention of the known risk factors for PSR remain the goal when performing TL. In particular, central compartment (para- and pretracheal) lymph nodes dissection in case of large tumors with extra-laryngeal and/or subglottic extension or pretreatment tracheotomy plays a paramount role in PSR prevention. SUMMARY Research is required to conclude the formulation of guidelines for proper dissection of the central compartment (level VI) lymph nodes as indicated either prophylactically or therapeutically during TL for preventing PSR.
Collapse
Affiliation(s)
- Patrick J Bradley
- Department Otorhinolaryngology, Head and Neck Surgery, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham, UK
| |
Collapse
|
3
|
Chen ML, Xu D, Yan XQ, Xie BJ. Delphian lymph node metastasis predicts occult contralateral carcinoma for unilateral papillary thyroid carcinoma patients with contralateral benign nodules. Asian J Surg 2023; 46:156-159. [PMID: 35277319 DOI: 10.1016/j.asjsur.2022.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/22/2022] [Accepted: 02/15/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND For unilateral PTC patients with benign nodules in the contralateral lobe evaluated preoperatively, the necessity of total thyroidectomy remains controversial. This study aimed to investigate the predictive factors for occult contralateral carcinoma and whether DLN metastasis could predict it. METHODS A total of 148 patients with unilateral PTC and contralateral benign nodules who were treated with a near-total thyroidectomy or TT at a single institution between August 2018 and April 2020 were enrolled. Clinicopathological features such as age, sex, TgAb or TPOAb level, primary tumor location, nodule number in contralateral lobe, carcinoma number in primary lobe, tumor size, capsular invasion, central lymph node metastasis, DLN metastasis were analyzed to investigate the rate and predictive factors of occult contralateral carcinoma. RESULTS 44.6% patients were diagnosed with occult contralateral thyroid carcinoma. Univariate analysis showed that sex (P = 0.008), mulifocality of primary carcinoma (P < 0.001), tumor size (P = 0.033), capsular invasion (P = 0.042), CLN metastasis (P = 0.004), DLN metastasis (P = 0.001) were associated with occult contralateral carcinoma. Multivariate analysis showed that multifocality of primary carcinoma (p = 0.000, OR = 9.729), DLN metastasis (p = 0.042, OR = 4.701), capsular invasion (p = 0.022, OR = 2.909), and male patients (p = 0.006, OR = 3.926) were all independent predictive factors. CONCLUSION For unilateral PTC patients with benign nodules in the contralateral lobe evaluated preoperatively, multifocality of primary carcinoma, DLN metastasis, capsular invasion, and male patients are independent predictors of occult contralateral carcinoma. We suggest separate excision and frozen section of DLN intraoperatively, if DLNs were confirmed metastasized, a TT was highly recommended.
Collapse
Affiliation(s)
- Min-Long Chen
- Department of Surgical Oncology, Taizhou Hospital, Wenzhou Medical University, Linhai, Zhejiang Province, PR China
| | - Dong Xu
- Department of Surgical Oncology, Taizhou Hospital, Wenzhou Medical University, Linhai, Zhejiang Province, PR China
| | - Xing-Qiang Yan
- Department of Surgical Oncology, Taizhou Hospital, Wenzhou Medical University, Linhai, Zhejiang Province, PR China
| | - Bo-Jian Xie
- Department of Surgical Oncology, Taizhou Hospital, Wenzhou Medical University, Linhai, Zhejiang Province, PR China.
| |
Collapse
|
4
|
Alibakhshi A, Sheikhi S, Meshkati Yazd SM, Ardekani A, Ranjbar K, Shahriarirad R. The incidence and features of Delphian lymph node involvement in patients with papillary thyroid carcinoma. BMC Surg 2022; 22:320. [PMID: 35987629 PMCID: PMC9392353 DOI: 10.1186/s12893-022-01742-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/25/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction In papillary thyroid cancer patients, the extent of dissection is still a matter of debate. Evaluating Delphian lymph nodes (DLNs) during the surgery has been speculated as a valuable tool to determine the extent of dissection. Herein, we aimed to evaluate the incidence and features of DLNs involvement in patients with papillary thyroid carcinoma. Method We conducted this cross-sectional study among surgical cases of papillary thyroid cancer. Patients were divided based on their DLNs involvement status. Their age, gender, location of the mass, lymphatic involvement, tumor size, tumor characteristics, pathology report, and operation note features were compared between the two groups. Definitive pathology slides of the patients were evaluated regarding DLN features. Results Of the 61 patients (mean age: 38.2 ± 12.0), 45 (73.8%) were females. In 13 (21.3%) patients, DLNs involvement was reported. A statistically significant relationship was noted between DLNs involvement and other lymph nodes' involvement on the same side of the mass (P < 0.001), the opposite side (P = 0.041), and also central lymph nodes (P < 0.001). Vascular invasion was also significantly higher among patients with DLNs involvement (P = 0.012). Conclusion Since DLNs involvement is significantly associated with extensive nodal involvement, intraoperative evaluation of DLNs is recommended to establish the extent to which dissection should be performed.
Collapse
|
5
|
Qi Q, Xu P, Zhang C, Guo S, Huang X, Chen S, Li Y, Zhou A. Nomograms Combining Ultrasonic Features With Clinical and Pathological Features for Estimation of Delphian Lymph Node Metastasis Risk in Papillary Thyroid Carcinoma. Front Oncol 2022; 11:792347. [PMID: 35004316 PMCID: PMC8733604 DOI: 10.3389/fonc.2021.792347] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/25/2021] [Indexed: 11/16/2022] Open
Abstract
Background This work explores the clinical significance of Delphian lymph nodes (DLN) in thyroid papillary carcinoma (PTC). At the same time, a nomogram is constructed based on clinical, pathological, and ultrasonic (US) features to evaluate the possibility of DLN metastasis (DLNM) in PTC patients. This is the first study to predict DLNM using US characteristics. Methods A total of 485 patients, surgically diagnosed with PTC between February 2017 and June 2021, all of whom underwent thyroidectomy, were included in the study. Using the clinical, pathological, and US information of patients, the related factors of DLNM were retrospectively analyzed. The risk factors associated with DLNM were identified through univariate and multivariate analyses. According to clinical + pathology, clinical + US, and clinical + US + pathology, the predictive nomogram for DLNM was established and validated. Results Of the 485 patients with DLN, 98 (20.2%) exhibited DLNM. The DLNM positive group had higher positive rates of central lymph node metastasis (CLNM), lateral lymph node metastasis (LLNM), and T3b–T4b thyroid tumors than the negative rates. The number of CLNM and LLNM lymph nodes in the DLNM+ group was higher as compared to that in the DLNM- group. Multivariate analysis demonstrated that the common independent risk factors of the three prediction models were male, bilaterality, and located in the isthmus. Age ≥45 years, located in the lower pole, and nodural goiter were protective factors. In addition, the independent risk factors were classified as follows: (I) P-extrathyroidal extension (ETE) and CLNM based on clinical + pathological characteristics; (II) US-ETE and US-CLNM based on clinical + US characteristics; and (III) US-ETE and CLNM based on clinical +US + pathological features. Better diagnostic efficacy was reported with clinical + pathology + US diagnostic model than that of clinical + pathology diagnostic model (AUC 0.872 vs. 0.821, p = 0.039). However, there was no significant difference between clinical + pathology + US diagnostic model and clinical + US diagnostic model (AUC 0.872 vs. 0.821, p = 0.724). Conclusions This study found that DLNM may be a sign that PTC is more invasive and has extensive lymph node metastasis. By exploring the clinical, pathology, and US characteristics of PTC progression to DLNM, three prediction nomograms, established according to different combinations of features, can be used in different situations to evaluate the transfer risk of DLN.
Collapse
Affiliation(s)
- Qi Qi
- Department of Ultrasonography, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Pan Xu
- Department of Ultrasonography, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Cheng Zhang
- Department of Ultrasonography, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Suping Guo
- Department of Ultrasonography, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xingzhi Huang
- Department of Ultrasonography, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Songli Chen
- Department of Ultrasonography, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yaohui Li
- Department of Ultrasonography, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Aiyun Zhou
- Department of Ultrasonography, The First Affiliated Hospital of Nanchang University, Nanchang, China
| |
Collapse
|
6
|
Ko IK, Yoon DY, Baek S, Hong JH, Yun EJ, Lee IJ. Mediastinal Lymph Node Metastasis from Head and Neck Cancer: Predictive Factors and Imaging Features. TAEHAN YONGSANG UIHAKHOE CHI 2021; 82:1246-1257. [PMID: 36238410 PMCID: PMC9432359 DOI: 10.3348/jksr.2020.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 11/20/2022]
Abstract
Purpose To assess the predictive factors and describe the imaging features of mediastinal lymph node (MLN) metastases in patients with head and neck cancer. Materials and Methods We compared the clinical features and disease characteristics (sex, age, site of primary tumor, histologic type, history of prior treatments, TNM stages, and metastasis in cervical LNs) of patients with head and neck cancers between the MLN metastasis and no MLN metastasis groups. We also evaluated the chest CT (distribution and maximum dimension of the largest LN) and PET/CT (maximum standardized uptake value) features of MLN metastases based on the MLN classification. Results Of the 470 patients with head and neck cancer, 55 (11.7%) had MLN metastasis, involving 150 mediastinal stations. Hypopharynx cancer, recurrent tumor, T4 stage, N2/N3 stages, and M1 stage were found to be significant predicting factors for MLN metastasis. The most common location of MLN metastasis was ipsilateral station 2 (upper paratracheal LNs, 36.4%), followed by ipsilateral station 11 (interlobar LNs, 27.3%) and ipsilateral station 10 (hilar LNs, 25.5%). Conclusion Metastasis to MLNs should be considered in patients with head and neck cancer, especially in cases that are associated with a hypopharyngeal cancer, recurrent tumor, and high TNM stages.
Collapse
|
7
|
Kim DH, Kim SW, Hwang SH. Predictive Value of Delphian Lymph Node Metastasis in the Thyroid Cancer. Laryngoscope 2021; 131:1990-1996. [PMID: 33493364 DOI: 10.1002/lary.29426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/08/2021] [Accepted: 01/14/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE/HYPOTHESIS To evaluate the diagnostic accuracy of Delphian lymph node (DLN) metastasis for the prediction of central lymph node (CLN) metastasis and lateral lymph node (LLN) metastasis. METHODS Two authors independently reviewed the six databases (Cochrane database, Embase, Google Scholar, PubMed, SCOPUS, and Web of Science). Four parameters were extracted from each study: true positive, true negative, false positive, and false negative. The quality of the methodology was evaluated using the Quality Assessment of Diagnostic Accuracy Studies ver. 2 tool. RESULTS The diagnostic odds ratio of DLN in CLN metastasis was 8.859 (95% confidence interval [CI], 4.419; 16.578). The area under the summary receiver operating characteristic curve was 0.748. The diagnostic odds ratio of DLN in LLN metastasis was 7.61 (95% CI, 4.48; 12.94). The area under the summary receiver operating characteristic curve was 0.837. DLN metastasis was moderately predictive of CLN metastasis (sensitivity = 32%, specificity = 95%), LLN metastasis (sensitivity = 52%, specificity = 89%), and contralateral CLN metastasis (sensitivity = 46%, specificity = 85%). DLN metastasis had statistically significant correlation with specific clinicopathological characteristics, including younger age (< 45 years old), bilaterality, capsule invasion, extrathyroidal extension, lymphovascular invasion, male sex, multifocality, and tumor size (> 1 cm). CONCLUSIONS The higher specificities of DLN pathology may help predict central and lateral compartment involvement in patients with thyroid cancer. LEVEL OF EVIDENCE NA Laryngoscope, 131:1990-1996, 2021.
Collapse
Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung Won Kim
- Department of Otolaryngology Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Se Hwan Hwang
- Department of Otolaryngology Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| |
Collapse
|
8
|
The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Ann Surg 2020; 271:e21-e93. [PMID: 32079830 DOI: 10.1097/sla.0000000000003580] [Citation(s) in RCA: 222] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To develop evidence-based recommendations for safe, effective, and appropriate thyroidectomy. BACKGROUND Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the US. METHODS The medical literature from 1/1/1985 to 11/9/2018 was reviewed by a panel of 19 experts in thyroid disorders representing multiple disciplines. The authors used the best available evidence to construct surgical management recommendations. Levels of evidence were determined using the American College of Physicians grading system, and management recommendations were discussed to consensus. Members of the American Association of Endocrine Surgeons reviewed and commented on preliminary drafts of the content. RESULTS These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Fine Needle Aspiration Biopsy Diagnosis, Molecular Testing, Indications, Extent and Outcomes of Surgery, Preoperative Care, Initial Thyroidectomy, Perioperative Tissue Diagnosis, Nodal Dissection, Concurrent Parathyroidectomy, Hyperthyroid Conditions, Goiter, Adjuncts and Approaches to Thyroidectomy, Laryngology, Familial Thyroid Cancer, Postoperative Care and Complications, Cancer Management, and Reoperation. CONCLUSIONS Evidence-based guidelines were created to assist clinicians in the optimal surgical management of thyroid disease.
Collapse
|
9
|
Gong JX, Gu JW, Ji F, Li K, Zhu Q, Gu FY, Chen Y, Ji QH. Clinical Study on Prelaryngeal Lymph Node Metastasis in Papillary Thyroid Carcinoma. Cancer Manag Res 2020; 12:1323-1327. [PMID: 32110106 PMCID: PMC7041594 DOI: 10.2147/cmar.s232884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 11/26/2019] [Indexed: 11/27/2022] Open
Abstract
Objective This study aims to investigate the risk factors of prelaryngeal lymph node metastasis in papillary thyroid carcinoma and its clinical application value. Methods The clinical pathological features and metastatic risks were statistically analyzed by reviewing 254 patients with papillary thyroid carcinoma, who received their first operation and prelaryngeal lymph node dissection in our department. Results The detection of prelaryngeal lymph nodes, tumor size and any paratracheal lymph node metastasis were correlated with the number of paratracheal lymph node metastasis (P<0.05), but these were not correlated with age, gender, multiple foci, tumor size, any paratracheal lymph node metastasis, metastatic location, or foci location (P>0.05). Conclusion Paratracheal lymph node metastasis indicates a high possibility of prelaryngeal lymph node metastasis. Paratracheal lymph node dissection combined with prelaryngeal lymph node dissection should be simultaneously considered in operations for thyroid papilla carcinoma.
Collapse
Affiliation(s)
- Jin-Xing Gong
- Department Four of Surgery, Kunshan Hospital of Traditional Chinese Medicine, Kunshan 215300, People's Republic of China
| | - Jian-Wei Gu
- Department Four of Surgery, Kunshan Hospital of Traditional Chinese Medicine, Kunshan 215300, People's Republic of China
| | - Feng Ji
- Department Four of Surgery, Kunshan Hospital of Traditional Chinese Medicine, Kunshan 215300, People's Republic of China
| | - Kun Li
- Department Four of Surgery, Kunshan Hospital of Traditional Chinese Medicine, Kunshan 215300, People's Republic of China
| | - Qi Zhu
- Department Four of Surgery, Kunshan Hospital of Traditional Chinese Medicine, Kunshan 215300, People's Republic of China
| | - Fang-Ying Gu
- Department Four of Surgery, Kunshan Hospital of Traditional Chinese Medicine, Kunshan 215300, People's Republic of China
| | - Yan Chen
- Department Four of Surgery, Kunshan Hospital of Traditional Chinese Medicine, Kunshan 215300, People's Republic of China
| | - Qing-Hai Ji
- Head & Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200000, People's Republic of China
| |
Collapse
|
10
|
Huang J, Sun W, Zhang H, Zhang P, Wang Z, Dong W, He L, Zhang T. Use of Delphian lymph node metastasis to predict central and lateral involvement in papillary thyroid carcinoma: A systematic review and meta-analysis. Clin Endocrinol (Oxf) 2019; 91:170-178. [PMID: 30851206 DOI: 10.1111/cen.13965] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/02/2019] [Accepted: 03/05/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Whether Delphian lymph node (DLN) metastasis is a reliable predictor of widespread lymph node metastasis in papillary thyroid carcinoma (PTC) remains controversial. This meta-analysis investigated the value of DLN metastasis for predicting central and lateral involvement in PTC. DESIGN AND METHODS A literature search using the PubMed, SCIE and the Chinese National Knowledge Infrastructure (CNKI) databases was conducted. Two reviewers independently extracted data and evaluated the studies for inclusion. Fixed-effects and random-effects models were used to analyse the data based on their heterogeneity. A sensitivity analysis was performed, and publication bias was assessed using Begg's funnel plot and Egger's linear regression test. RESULTS Data from 10 studies were analysed. The risk of central lymph node (CLN) metastasis was significantly higher in the DLN-positive group than in the DLN-negative group (OR = 9.05, 95% CI: 5.13-15.99) with moderate heterogeneity (P = 0.022, I2 = 53.5%). The risk of lateral lymph node (LLN) metastasis was significantly higher in the DLN-positive group than in the negative group (OR = 10.88, 95% CI: 7.60-15.58), with low heterogeneity (P = 0.603, I2 = 0.0%). Sensitivity analysis indicated that the results were stable and credible, and no publication bias was found. CONCLUSIONS Delphian lymph node metastasis is valuable for predicting central and lateral compartment involvement in patients with PTC. The DLN of PTC patients should be dissected intraoperatively and sent for frozen section consultation. If the result is positive, the CLNs should be thoroughly dissected and the LLNs should be further evaluated.
Collapse
Affiliation(s)
- Jiapeng Huang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Wei Sun
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Hao Zhang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Ping Zhang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Zhihong Wang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Wenwu Dong
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Liang He
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Ting Zhang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| |
Collapse
|
11
|
Ormeci T, Çolakoğulları M, Orhan İ. Importance of Delphian Lymph Node Evaluation in Autoimmune Thyroiditis: Fact or Fiction? Pol J Radiol 2016; 81:72-9. [PMID: 26985243 PMCID: PMC4771092 DOI: 10.12659/pjr.895761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 09/16/2015] [Indexed: 11/21/2022] Open
Abstract
Background Our main objective was to evaluate the association between autoimmune thyroiditis and the Delphian lymph node during different stages of thyroiditis. Material/Methods The relationships between the ultrasonography (US) results of thyroiditis and characteristics of the Delphian lymph node in different stages of AT were evaluated. Thyroid hormone and antibody levels were assessed. A total of 126 patients were divided into four groups according to the thyroid US findings: Group 1: control cases; Group 2: indeterminate cases; Group 3: established thyroiditis cases; Group 4: advanced-late stage thyroiditis cases. Indeterminate cases attended a 1-year follow-up, and the cases with a sonographic finding matching thyroiditis formed Group 2. Results The rate of Delphian lymph node presence in Group 4 was significantly higher than in Groups 1 and 2 (p<0.01). In addition, its presence was significantly higher in Group 3 than in Group 1 (p<0.05). Although there was a difference in Delphian lymph node presence between Groups 2 and 3, it was not significant (p=0.052), nor was there a significant difference between Groups 1 and 2 (p>0.05). Both the long and short axis measurements were significantly higher in Groups 2, 3, and 4 compared to those in the control group. However, the same increase was not observed in the long/short axis ratio. Conclusions Both the presence and dimensions of the Delphian lymph node were highly correlated with the progress of autoimmune thyroiditis. Evaluating the Delphian lymph nodes might prevent missing a diagnosis of autoimmune thyroiditis.
Collapse
Affiliation(s)
- Tugrul Ormeci
- Department of Radiology, Medipol University, Istanbul, Turkey
| | | | - İsrafil Orhan
- Department of Otorhinolaryngology, Sütçü İmam University, Kahramanmaraş, Turkey
| |
Collapse
|
12
|
Tan Z, Ge MH, Zheng CM, Wang QL, Nie XL, Jiang LH. The significance of Delphian lymph node in papillary thyroid cancer. Asia Pac J Clin Oncol 2016; 13:e389-e393. [PMID: 26990889 DOI: 10.1111/ajco.12480] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 01/08/2016] [Accepted: 01/20/2016] [Indexed: 11/28/2022]
Abstract
AIM To investigate the clinical significance of the DLN metastasis in papillary thyroid cancer (PTC). METHODS A total of 231 PTC patients who underwent first surgical treatment in the Department of Hand and Neck Surgery of Zhejiang Cancer Hospital from January 2013 to June 2014 were enrolled. The relationship between Delphian lymph node (DLN) metastasis and patient age, gender, tumor size, tumor number, unilateral or bilateral, capsular invasion, pretracheal and paratracheal node metastasis, and lateral node metastasis was analyzed. RESULTS Within 231 cases, 69 showed DLN, but only 19 (8.23%) were found with metastasis. In the univariate analysis, DLN metastasis was significantly associated with tumor size (P = 0.023), capsular invasion (P = 0.001), pretracheal or paratracheal node metastasis (P = 0.003) and lateral node metastasis (P = 0.001), while there were no significant correlation between DLN metastasis and gender (P = 0.976), age (P = 0.976), tumor number (P = 0.234) and unilateral or bilateral (P = 0.724). In the multivariate analysis, capsular invasion was an independent risk factor of DLN metastasis (P < 0.05, odds ratio = 10.15). CONCLUSION Capsular invasion is an independent risk factor of DLN metastasis and DLN metastasis could be used as a predictor of lateral node metastasis. The dissection of DLN in PTC patients is recommended and lateral lymph node should be evaluated for patients with DLN positive.
Collapse
Affiliation(s)
- Zhuo Tan
- Department of Head and Neck Surgery, Zhejiang Cancer Hospital, Hangzhou, China
| | - Ming-Hua Ge
- Department of Head and Neck Surgery, Zhejiang Cancer Hospital, Hangzhou, China
| | - Chuan-Ming Zheng
- Department of Head and Neck Surgery, Zhejiang Cancer Hospital, Hangzhou, China
| | - Qing-Liang Wang
- Department of Head and Neck Surgery, Zhejiang Cancer Hospital, Hangzhou, China
| | - Xi-Lin Nie
- Department of Head and Neck Surgery, Zhejiang Cancer Hospital, Hangzhou, China
| | - Lie-Hao Jiang
- Department of Head and Neck Surgery, Zhejiang Cancer Hospital, Hangzhou, China
| |
Collapse
|
13
|
Huang H, Liu SY, Ni S, Zhang ZM, Wang XL, Xu ZG. Treatment Outcome of Papillary Carcinoma Confined to the Thyroid Isthmus. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/jct.2016.712093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
14
|
Feng Z, Niu LX, Zhang JY, Gao Y, Guo CB. Neck recurrence of oral squamous cell carcinoma in unusual sites: Retrospective study of 1658 cases. Head Neck 2015; 38 Suppl 1:E680-6. [DOI: 10.1002/hed.24070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 01/14/2015] [Accepted: 04/13/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Zhien Feng
- Department of Oral and Maxillofacial Surgery; School of Stomatology, Peking University; Beijing China
| | - Li Xuan Niu
- Department of Oral and Maxillofacial Surgery; School of Stomatology, Peking University; Beijing China
| | - Jian Yun Zhang
- Department of Pathology; School of Stomatology, Peking University; Beijing China
| | - Yan Gao
- Department of Pathology; School of Stomatology, Peking University; Beijing China
| | - Chuan Bin Guo
- Department of Oral and Maxillofacial Surgery; School of Stomatology, Peking University; Beijing China
| |
Collapse
|
15
|
Chai YJ, Kim SJ, Choi JY, Koo DH, Lee KE, Youn YK. Papillary thyroid carcinoma located in the isthmus or upper third is associated with Delphian lymph node metastasis. World J Surg 2015; 38:1306-11. [PMID: 24366273 DOI: 10.1007/s00268-013-2406-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Delphian lymph node (DLN) metastasis is a recognized indicator of further lymph node involvement in papillary thyroid carcinoma (PTC). The aim of this study was to evaluate the clinicopathological significance of and risk factors for DLN metastasis. METHODS The medical records of 1,436 patients who underwent primary thyroidectomy for classical PTC with a tumor size of 2 cm or less were reviewed. Of these, 370 patients from whom the DLN was harvested were enrolled. Metastasis in DLN was present in 46 patients and absent in 324 patients. Clinicopathological features were compared according to DLN metastasis. RESULTS In univariate analysis, DLN metastasis was associated with suspected lymph node metastasis on preoperative ultrasonography, tumor location in the isthmus or upper third of the thyroid, larger tumor size, extrathyroid extension, lymphovascular invasion, and further lymph node metastasis. Multivariable analysis revealed that DLN metastasis was associated with tumor location in the isthmus or upper third of the thyroid (odds ratio [OR] = 2.420; 95 % confidence interval [CI] 1.193-4.910) and further lymph node metastasis (OR = 4.746; 95 % CI 2.065-10.908). CONCLUSIONS DLN metastasis in PTC is associated with tumor location in the isthmus or upper third of the thyroid and unfavorable clinicopathological characteristics. Careful consideration and patient management are warranted when preoperative ultrasonography indicates that the tumor is located in the isthmus or upper third of the thyroid.
Collapse
Affiliation(s)
- Young Jun Chai
- Department of Surgery, Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea
| | | | | | | | | | | |
Collapse
|
16
|
Clinical Significance of Delphian Lymph Node Metastasis in Papillary Thyroid Carcinoma. World J Surg 2013; 37:2594-9. [DOI: 10.1007/s00268-013-2157-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
17
|
Teymoortash A, Werner JA. Current advances in diagnosis and surgical treatment of lymph node metastasis in head and neck cancer. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2012; 11:Doc04. [PMID: 23320056 PMCID: PMC3544246 DOI: 10.3205/cto000086] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Still today, the status of the cervical lymph nodes is the most important prognostic factor for head and neck cancer. So the individual treatment concept of the lymphatic drainage depends on the treatment of the primary tumor as well as on the presence or absence of suspect lymph nodes in the imaging diagnosis. Neck dissection may have either a therapeutic objective or a diagnostic one. The selective neck dissection is currently the method of choice for the treatment of patients with advanced head and neck cancers and clinical N0 neck. For oncologic reasons, this procedure is generally recommended with acceptable functional and aesthetic results, especially under the aspect of the mentioned staging procedure. In this review article, current aspects on pre- and posttherapeutic staging of the cervical lymph nodes are described and the indication and the necessary extent of neck dissection for head and neck cancer is discussed. Additionally the critical question is discussed if the lymph node metastasis bears an intrinsic risk of metastatic development and thus its removal in a most possible early stage plays an important role.
Collapse
Affiliation(s)
- A. Teymoortash
- Department of Otolaryngology, Head & Neck Surgery, University of
Marburg, Germany
| | - J. A. Werner
- Department of Otolaryngology, Head & Neck Surgery, University of
Marburg, Germany
| |
Collapse
|
18
|
Afectación ganglionar en el cáncer de laringe y actitud terapéutica. Semergen 2012; 38:491-7. [DOI: 10.1016/j.semerg.2011.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 12/15/2011] [Indexed: 11/20/2022]
|
19
|
Kim WW, Yang SI, Kim JH, Choi YS, Park YH, Kwon SK. Experience and analysis of Delphian lymph node metastasis in patients with papillary thyroid carcinoma. World J Surg Oncol 2012; 10:226. [PMID: 23110552 PMCID: PMC3542107 DOI: 10.1186/1477-7819-10-226] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 09/21/2012] [Indexed: 11/22/2022] Open
Abstract
Background Recently, lymph node metastasis (LNM) has been regarded as an important factor influencing loco-regional recurrence and survival rate in papillary thyroid cancer (PTC) patients. The aims of this study were to investigate the detection rate and metastasis rate of the Delphian lymph node (DLN) and clinical patterns related to regional LNM, and to examine how DLN metastasis affects PTC treatment. Methods We reviewed the medical records of 413 patients with pathologically confirmed PTC from among 452 patients who underwent thyroid surgery between January 2010 and October 2010 in the Department of Endocrine Surgery at Kosin University Gospel Hospital in Busan, South Korea. Results Multivariate analyses revealed a significantly higher proportion of cases with lymphovascular invasion (56.6% vs. 12.5%, P <0.001), central neck node metastasis (88.6% vs. 34.5%, P <0.001) and lateral neck node metastasis (47.2% vs. 10.2%, P <0.005) among cases with DLN metastasis compared to those without. The negative predictive value (NPV) of DLN metastasis with regard to the presence of contralateral central LNM for cases with a tumor size 1 cm or smaller than 1 cm was found to be 93.3% (127/136). Conclusion When DLN metastasis is not detected in papillary thyroid microcarcinomas (PTMC), thyroid lobectomy on the affected side and ipsilateral central neck lymph node dissection should be sufficient. In addition, even in cases where lateral neck LNM is not detected on preoperative examination, if DLN metastasis is detected postoperatively, more careful attention should be paid to the lateral neck nodes during follow-up.
Collapse
Affiliation(s)
- Won Woong Kim
- Department of Surgery, Kosin University College of Medicine, 34 Amnam-dong, Seo-gu, Busan, Korea
| | | | | | | | | | | |
Collapse
|
20
|
Liao CT, Lin CY, Fan KH, Hsueh C, Lee LY, Wang HM, Huang SF, Chen IH, Kang CJ, Ng SH, Lin CH, Huang YC, Yen TC. Outcome analyses of unusual site neck recurrence in oral cavity cancer. Ann Surg Oncol 2012; 20:257-66. [PMID: 22872292 DOI: 10.1245/s10434-012-2580-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Indexed: 11/18/2022]
Abstract
AIM To understand the frequency, clinical significance, and benefits of salvage therapy in oral cavity squamous cell carcinoma (OSCC) patients with regional nodal recurrence at unusual sites (prelaryngeal area, parotid area, and retropharyngeal area). METHODS We examined 178 patients with neck recurrence at levels I-V (usual group) and 26 patients outside levels I-V (unusual group). The 5-year survival rates served as the main outcome measure. RESULTS Of the 26 unusual group patients, the neck recurrence sites were as follows: 5 at the prelaryngeal area, 13 at the parotid area, and 8 at the retropharyngeal area. Multivariate analyses demonstrated that poor differentiation, pN2, extracapsular spread (ECS), tumor depth≥10 mm, relapse time≤10 months, local recurrence, neck recurrence at unusual sites, and distant metastases were independent prognostic factors for 5-year disease-specific survival (DSS), whereas pN2, ECS, tumor depth≥10 mm, relapse time≤10 months, neck recurrence at unusual sites, and distant metastases were independent prognostic factors for 5-year overall survival (OS). The 6-month and 18-month survival rates after the N-relapse date for the salvaged-usual group, the salvaged-unusual group, and the nonsalvaged patients were 73%/46%, 40%/0%, and 10%/0% (P<0.0001), respectively [DSS: salvaged-unusual group (hazard ratio/95 % confidence interval), 2.060/1.058-4.008, P=0.033; salvaged-usual group, 6.420/4.340-9.496, P<0.001; OS: salvaged-unusual group, 2.100/1.080-4.081, P=0.029; salvaged-usual group, 6.514/4.418-9.606, P<0.001]. CONCLUSIONS Our findings demonstrate that OSCC patients with regional nodal recurrence at unusual sites had poor outcomes.
Collapse
Affiliation(s)
- Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, Republic of China
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Central compartment dissection for well differentiated thyroid cancer … and the band plays on. Curr Opin Otolaryngol Head Neck Surg 2011; 19:106-12. [PMID: 21252666 DOI: 10.1097/moo.0b013e328343af58] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The role of central compartment dissection in the surgical management of well differentiated thyroid cancer is controversial. Lack of high-quality prospective studies results in management decisions being based on expert opinions and weaker levels of evidence. The American Thyroid Association has recently revised its management guidelines with particular emphasis on this topic, and a separate working group has set out to define the surgical anatomy that encompasses this procedure. RECENT FINDINGS Central compartment dissection comprises the removal of nodal tissue from the prelaryngeal, pretracheal and paratracheal compartments, with no role for berry-picking procedures. There is universal agreement that therapeutic nodal dissection should be performed in patients with metastatic disease detected either through preoperative imaging or during intraoperative evaluation of the central compartment, with either visual inspection or frozen-section pathology. In contrast, there may be limited benefit from routine prophylactic central compartment dissection, for either disease recurrence or survival outcomes. As such, it should be performed only in patients deemed high risk: larger tumors, extra-thyroidal extension or aggressive histologic subtypes. SUMMARY Future studies should focus on identifying the subpopulation of patients who would most benefit from these procedures and spare low-risk patients from the unwanted complications.
Collapse
|
22
|
The impact of prelaryngeal node metastases on early glottic cancer treatment results. Eur Arch Otorhinolaryngol 2011; 269:193-9. [DOI: 10.1007/s00405-011-1747-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 08/11/2011] [Indexed: 10/17/2022]
|
23
|
Nakayama M, Seino Y, Okamoto M, Mikami T, Okamoto T, Miyamoto S. Clinical Significance of Positive Delphian Node in Supracricoid Laryngectomy with Cricohyoidoepiglottopexy. Jpn J Clin Oncol 2011; 41:987-91. [DOI: 10.1093/jjco/hyr091] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
|