2
|
Graceffa G, Orlando G, Cocorullo G, Mazzola S, Vitale I, Proclamà MP, Amato C, Saputo F, Rollo EM, Corigliano A, Melfa G, Cipolla C, Scerrino G. Predictors of Central Compartment Involvement in Patients with Positive Lateral Cervical Lymph Nodes According to Clinical and/or Ultrasound Evaluation. J Clin Med 2021; 10:jcm10153407. [PMID: 34362189 PMCID: PMC8347254 DOI: 10.3390/jcm10153407] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 11/21/2022] Open
Abstract
Lymph node neck metastases are frequent in papillary thyroid carcinoma (PTC). Current guidelines state, on a weak level of evidence, that level VI dissection is mandatory in the presence of latero-cervical metastases. The aim of our study is to evaluate predictive factors for the absence of level VI involvement despite the presence of metastases to the lateral cervical stations in PTC. Eighty-eight patients operated for PTC with level II–V metastases were retrospectively enrolled in the study. Demographics, thyroid function, autoimmunity, nodule size and site, cancer variant, multifocality, Bethesda and EU-TIRADS, number of central and lateral lymph nodes removed, number of positive lymph nodes and outcome were recorded. At univariate analysis, PTC location and number of positive lateral lymph nodes were risk criteria for failure to cure. ROC curves demonstrated the association of the number of positive lateral lymph nodes and failure to cure. On multivariate analysis, the protective factors were PTC located in lobe center and number of positive lateral lymph nodes < 4. Kaplan–Meier curves confirmed the absence of central lymph nodes as a positive prognostic factor. In the selected cases, Central Neck Dissection (CND) could be avoided even in the presence of positive Lateralcervical Lymph Nodes (LLN+).
Collapse
Affiliation(s)
- Giuseppa Graceffa
- Unit of Oncological Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via del Vespro, 129, 90127 Palermo, Italy; (G.G.); (F.S.); (E.M.R.); (C.C.)
| | - Giuseppina Orlando
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico P. Giaccone, University of Palermo, Via L Giuffré, 5, 90127 Palermo, Italy; (G.C.); (I.V.); (M.P.P.); (C.A.); (G.M.)
- Correspondence:
| | - Gianfranco Cocorullo
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico P. Giaccone, University of Palermo, Via L Giuffré, 5, 90127 Palermo, Italy; (G.C.); (I.V.); (M.P.P.); (C.A.); (G.M.)
| | - Sergio Mazzola
- Unit of Clinical Epidemiology & Tumor Registry, Department of Laboratory Diagnostics, Policlinico P. Giaccone, University of Palermo, Via L Giuffré, 5, 90127 Palermo, Italy;
| | - Irene Vitale
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico P. Giaccone, University of Palermo, Via L Giuffré, 5, 90127 Palermo, Italy; (G.C.); (I.V.); (M.P.P.); (C.A.); (G.M.)
| | - Maria Pia Proclamà
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico P. Giaccone, University of Palermo, Via L Giuffré, 5, 90127 Palermo, Italy; (G.C.); (I.V.); (M.P.P.); (C.A.); (G.M.)
| | - Calogera Amato
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico P. Giaccone, University of Palermo, Via L Giuffré, 5, 90127 Palermo, Italy; (G.C.); (I.V.); (M.P.P.); (C.A.); (G.M.)
| | - Federica Saputo
- Unit of Oncological Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via del Vespro, 129, 90127 Palermo, Italy; (G.G.); (F.S.); (E.M.R.); (C.C.)
| | - Enza Maria Rollo
- Unit of Oncological Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via del Vespro, 129, 90127 Palermo, Italy; (G.G.); (F.S.); (E.M.R.); (C.C.)
| | - Alessandro Corigliano
- Unit of Endocrine Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico P. Giaccone, University of Palermo, Via L Giuffré, 5, 90127 Palermo, Italy; (A.C.); (G.S.)
| | - Giuseppina Melfa
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico P. Giaccone, University of Palermo, Via L Giuffré, 5, 90127 Palermo, Italy; (G.C.); (I.V.); (M.P.P.); (C.A.); (G.M.)
| | - Calogero Cipolla
- Unit of Oncological Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via del Vespro, 129, 90127 Palermo, Italy; (G.G.); (F.S.); (E.M.R.); (C.C.)
| | - Gregorio Scerrino
- Unit of Endocrine Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico P. Giaccone, University of Palermo, Via L Giuffré, 5, 90127 Palermo, Italy; (A.C.); (G.S.)
| |
Collapse
|
3
|
Fraser S, Zaidi N, Norlén O, Glover A, Kruijff S, Sywak M, Delbridge L, Sidhu SB. Incidence and Risk Factors for Occult Level 3 Lymph Node Metastases in Papillary Thyroid Cancer. Ann Surg Oncol 2016; 23:3587-3592. [PMID: 27188295 DOI: 10.1245/s10434-016-5254-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Papillary thyroid cancer (PTC) frequently disseminates into cervical lymph nodes. Lateral node involvement is described in up to 50 % patients undergoing prophylactic lateral neck dissection. This study aimed to assess this finding and identify which factors predict for occult lateral node disease. METHODS Patients with fine needle aspiration-confirmed PTC (Bethesda V or VI), without evidence of cervical lymph node metastases, underwent a total thyroidectomy with prophylactic ipsilateral central and level 3 dissection. Level 3 nodes were removed by compartmental dissection or by sampling the sentinel nodes overlying the jugular vein, according to surgeon preference. Data were collected prospectively from January 2011 to August 2014. Statistical analysis was performed by SPSS software. RESULTS A total of 137 patients underwent total thyroidectomy with prophylactic ipsilateral central and level 3 dissection for PTC. The incidence of occult level 3 disease was 30 % (41/137 patients). A total of 48 % of patients (66/137) harbored occult central neck disease. A total of 80.5 % of patients with pN1b disease had macrometastases (≥2 mm), and 15 % exhibited skip metastases with central compartment sparing. In patients with pN1b disease, a median of 6 level 3 nodes were retrieved, with an average involved nodal ratio of 0.29. Multivariate regression demonstrated risk factors for occult lateral neck metastasis include tumor size (odds ratio 1.1), upper pole tumors (odds ratio 6.6), and vascular invasion (odds ratio 3.2) (p < 0.05). CONCLUSIONS PTC is associated with a significant incidence of occult central and lateral nodal metastases. In patients undergoing prophylactic central neck dissection, inclusion of level 3 dissection should be considered in patients with large upper lobe cancers.
Collapse
Affiliation(s)
- Sheila Fraser
- Endocrine Surgery Unit, Royal North Shore Hospital, University of Sydney, St. Leonards, NSW, Australia.
| | - Nisar Zaidi
- Endocrine Surgery Unit, Royal North Shore Hospital, University of Sydney, St. Leonards, NSW, Australia
| | - Olov Norlén
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anthony Glover
- Kolling Institute of Medical Research, University of Sydney, St. Leonards, Australia
| | - Schelto Kruijff
- Department of Surgical Oncology, University Medical Centre Groningen, Groningen, Netherlands
| | - Mark Sywak
- Endocrine Surgery Unit, Royal North Shore Hospital, University of Sydney, St. Leonards, NSW, Australia
| | - Leigh Delbridge
- Endocrine Surgery Unit, Royal North Shore Hospital, University of Sydney, St. Leonards, NSW, Australia
| | - Stan B Sidhu
- Endocrine Surgery Unit, Royal North Shore Hospital, University of Sydney, St. Leonards, NSW, Australia.,Kolling Institute of Medical Research, University of Sydney, St. Leonards, Australia
| |
Collapse
|
4
|
Recurrence of papillary thyroid carcinoma with lateral cervical node metastases: Predictive factors and operative management. Surgery 2015; 159:755-62. [PMID: 26435440 DOI: 10.1016/j.surg.2015.08.033] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 07/04/2015] [Accepted: 08/31/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND Lateral neck lymph node (LN) metastases (N1b) have been identified as independent risk factors of recurrence in patients with papillary thyroid carcinoma (PTC). OBJECTIVE This study aimed to determine the predictive factors of recurrence in N1b PTC patients and to clarify the postoperative event patterns. METHODS All patients who underwent operation for N1b PTC between 1978 and 2012 were reviewed. The median follow-up period was 6.5 years. RESULTS In total, 344 N1b patients were included. Twenty-four patients (7%) were lost to long-term follow-up. Among the remaining 320 patients, the mean (± SD) follow-up time was 8.9 ± 8.8 years (median, 6.5; range, 2-36.4). Eighty-two patients (26%) presented with lymph node recurrence (LR). Multivariate analyses showed that LN metastases with extracapsular extension and the LN ratio (ratio between the number of N1 and number of resected LN) in the lateral compartment were independent predictors of recurrent disease. The median time to reoperation was 19 months (range, 3-173), with 79% of reoperations occurring within 2 years after the initial thyroidectomy. Reoperations for LR (75 patients) were performed in 76% of the patients with a focused minimal access approach or selective LN dissection. After curative reoperative surgery for recurrence, complications occurred in 6 patients (8%), including a 1% permanent complication rate. CONCLUSION Extranodal extension of LN metastases and the LN ratio in the lateral compartment are prognostic factors for recurrence. In most cases, reoperation for LR can be performed with a focused minimal access approach, with a low morbidity rate.
Collapse
|