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Long B, Luo M, Zhou K, Zheng T, Li W. Risk factors and distribution pattern of lateral lymph node recurrence after central neck dissection for cN1a papillary thyroid carcinoma. BMC Surg 2024; 24:270. [PMID: 39334088 PMCID: PMC11428479 DOI: 10.1186/s12893-024-02564-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 09/06/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND The indication and extent of selective lateral neck dissection (LND) for cN1a papillary thyroid carcinoma (PTC) remain uncertain. The present study aimed to identify potential predictors and distribution pattern of lateral lymph node recurrence (LLNR) after central neck dissection in cN1a PTC patients. METHODS The cN1a PTC patients who underwent initial central neck dissection at our centre were retrospectively reviewed, and the median follow-up period was 6.8 years. Reoperation with LND was performed when LLNR was confirmed. Risk factors for LLNR were identified, and the metastatic status of each lateral level was recorded. RESULTS Of the 310 patients enrolled in the present study, fifty-eight patients (18.7%) presented with LLNR. Six independent factors, including tumour diameter, pathological T4 stage, number of involved central lymph nodes, pTNM stage, extrathyroidal extension, and I131 treatment (P values < 0.05) were identified via multivariate analysis. LLNR was found at level II in 26 patients (44.8%), level III in 38 patients (65.5%), level IV in 30 patients (51.7%), and level V in 8 patients (13.8%). The number of positive lateral lymph nodes at levels II, III, IV and V was 44 (22.9%), 76 (39.6%), 63 (32.8%), and 9 (4.9%), respectively. CONCLUSIONS For cN1a PTC patients who underwent central neck dissection, tumour diameter ≥ 2 cm, pathological T4 stage, number of involved central lymph nodes ≥ 3, pTNM stage III-IV, extrathyroidal extension, and failure to receive I131 treatment were independent predictors of LLNR, which was more likely to occur at levels III and IV.
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Affiliation(s)
- Binbin Long
- Department of General Surgery III, Taihe Hospital, Hubei University of Medicine, 32 Renmin South Road, Shiyan, Hubei, 442000, China
| | - Mingxu Luo
- Department of General Surgery, Xiamen Humanity Hospital Fujian Medical University, 3777 Xianyue Road, Xiamen, Fujian, 361000, China
| | - Ke Zhou
- Department of General Surgery III, Taihe Hospital, Hubei University of Medicine, 32 Renmin South Road, Shiyan, Hubei, 442000, China
| | - Tao Zheng
- Department of General Surgery III, Taihe Hospital, Hubei University of Medicine, 32 Renmin South Road, Shiyan, Hubei, 442000, China
| | - Wenfang Li
- Department of General Surgery III, Taihe Hospital, Hubei University of Medicine, 32 Renmin South Road, Shiyan, Hubei, 442000, China.
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Li Q, Huang C, Zou H, Zhang J, Xin J. Single-center external validation and reconstruction of multiple predictive models for skip lateral lymph node metastasis in papillary thyroid carcinoma. Front Endocrinol (Lausanne) 2024; 15:1366679. [PMID: 39319253 PMCID: PMC11420524 DOI: 10.3389/fendo.2024.1366679] [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: 01/07/2024] [Accepted: 08/05/2024] [Indexed: 09/26/2024] Open
Abstract
Objective The unique metastatic pattern of skip lateral lymph node metastasis (SLLNM) in PTC patients may lead to missed diagnosis of lateral cervical metastatic lymph nodes. Therefore, many different SLLNM prediction models were constructed. In this study, partially eligible models (Hu 2020, Wang 2020, and Zhao 2023 nomograms) were selected for external validation, and then new variables were incorporated for model reconstruction to extend clinical applicability. Methods 576 PTC patients from our center were selected to evaluate the performance of the three nomograms using the receiver operating characteristic curve (ROC), calibration curves, and decision curve analyses (DCA). Three new variables were added to calibrate the model, including assessment of LN status on ultrasound (US-SLLNM), the distance from the tumor to the capsule (Capsular distance), and the number of central lymph node dissections (CLND number). Univariate and multivariate logistic regression analyses were used to screen independent predictors to reconstruct the model, and 1000 Bootstrap internal validations were performed. Results SLLNM were present in 69/576 patients (12.0%). In external validation, the area under the ROC curves (AUCs) for Hu 2020, Wang 2020, and Zhao 2023 nomograms were 0.695 (95% CI:0.633-0.766), 0.792 (95% CI=0.73-0.845), and 0.769 (95% CI:0.713-0.824), respectively. The calibration curves for the three models were overall poorly fitted; DCA showed some net clinical benefit. Model differentiation and net clinical benefit improved by adding three new variables. Based on multivariate analysis, female, age, and maximum tumor diameter ≤ 10 mm, located at the upper pole, Capsular distance < 0mm, US-SLLNM, CLND number ≤ 5 were identified as independent predictors of SLLNM and were used to construct the new model. After 1000 Bootstrap internal validations, the mean AUC of the model was 0.870 (95% CI:0.839-0.901), the calibration curve was close to the ideal curve, and the net clinical benefit was significant. Conclusion Overall, these nomograms were well differentiated and provided some net clinical benefit, but with varying degrees of underestimation or overestimation of the actual risk and high false-negative rates. New dynamic nomogram was constructed based on the addition of new variables and larger samples, showing better performance.
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Affiliation(s)
- Qi Li
- Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Can Huang
- Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Hongrui Zou
- Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Jiaping Zhang
- Department of Otolaryngology Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Jingwei Xin
- Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
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Ma Y, Li Y, Zheng L, He Q. Prospective application of a prediction model for lateral lymph node metastasis in papillary thyroid cancer patients with central lymph node metastasis. Front Endocrinol (Lausanne) 2024; 14:1283409. [PMID: 38239987 PMCID: PMC10795756 DOI: 10.3389/fendo.2023.1283409] [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: 08/26/2023] [Accepted: 12/01/2023] [Indexed: 01/22/2024] Open
Abstract
Objective This study aimed to develop and apply a prediction model to estimate the probability of lateral lymph node metastasis (LLNM) in patients with cN0 unilateral papillary thyroid carcinoma (PTC) with central lymph node metastasis (CLNM). Setting All study data were collected from a single tertiary hospital. Methods Univariable and multivariable logistic regression analyses were used to explore independent predictors of LLNM in the derivation and internal validation cohorts, which were used to construct and validate a nomogram. Another 96 patients were included prospectively to evaluate the efficacy of this nomogram. Results Maximum tumor diameter greater than 1.0 cm (OR, 2.712; 95% CI, 1.412-5.210), multifocality (OR, 2.758; 95% CI, 1.120-6.789), the number of CLNM ≥3 (OR, 2.579; 95% CI, 1.315-5.789), CLNM ratio ≥0.297 (OR, 2.905; 95% CI, 1.396-6.043), and tumors located in the upper portion (OR 2.846, 95% CI 1.151-7.039) were independent predictors associated with LLNM. The prediction model showed excellent discrimination with an AUC of 0.731 (95% CI, 0.635-0.827). Novel risk stratification for LLNM was constructed based on this nomogram. In the prospective cohort, we stratified these patients into three risk subgroups: low-, moderate-, and high-risk subgroups and we found that the probability of LLNM was positively correlated with the total points from the nomogram. Conclusion This nomogram was applied in prospective clinical practice and distinguished PTC patients with a genuinely high risk of LLNM. Surgeons can use our nomogram to tailor the surgical plan and to credibly determine further postoperative therapy.
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Affiliation(s)
- Yunhan Ma
- Department of General Surgery, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
| | - Yi Li
- Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Luming Zheng
- Department of General Surgery, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
| | - Qingqing He
- Department of General Surgery, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
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Cetinoglu I, Aygun N, Yanar C, Caliskan O, Kostek M, Unlu MT, Uludag M. Can Unilateral Therapeutic Central Lymph Node Dissection Be Performed in Papillary Thyroid Cancer with Lateral Neck Metastasis? SISLI ETFAL HASTANESI TIP BULTENI 2023; 57:458-465. [PMID: 38268664 PMCID: PMC10805041 DOI: 10.14744/semb.2023.22309] [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: 12/13/2023] [Accepted: 12/26/2023] [Indexed: 01/26/2024]
Abstract
Objectives Unilateral or bilateral prophylactic central neck dissection (CND) in papillary thyroid cancer (PTC) is still controversial. We aimed to evaluate the risk factors for contralateral paratracheal lymph node metastasis and whether CND might be performed unilaterally. Methods Prospectively collected data of patients who underwent bilateral CND and lateral neck dissection (LND) with thyroidectomy due to PTC with lateral metastases, between January 2012 and November 2019, were evaluated retrospectively. The patients were divided into two groups according to the presence (Group 1) and absence (Group 2) of metastasis in the contralateral paratracheal region.A total of 42 patients (46 ±15.7 years) were operated. In the contralateral paratracheal region, Group 1 (35.7%) had metastases, while Group 2 (64.3%) had no metastases. In groups 1 and 2, metastasis rates were 100% vs 77.8% (p=0.073), 46.7% vs 18.5% (p=0.078), and 80% vs 40.7% (p=0.023) for the ipsilateralparatracheal, prelaryngeal and pretracheal lymph nodes, respectively.The number of metastatic lymph nodes in the central region was significantly higher in Group 1 compared to Group 2 as; 10.7±8.4 vs. 2.6±2.4 (p=0.001) in bilateral central region material; 8.3±7.4 vs. 2.9±2.7 (p=0.001) in lateral metastasis with ipsilateral unilateral central region; 3.8±3.4 vs. 1.9±1.9 (p=0.023) in ipsilateralparatracheal area; and 3.7±4.6 vs. 0.6±0.9 (p=0.001) in pretracheal region, respectively. However, no significant difference was found regarding the prelaryngeal region material (0.9±1.8 vs. 0.2±0.4 (p=0.71)). Results >2 metastatic central lymph nodes in unilateral CND material (AUC: 0.814, p<0.001, J=0.563) can estimate contralateral paratracheal metastasis with 93% sensitivity, 63% specificity, while >2 pretracheal metastatic lymph nodes (AUC: 0.795, p<0.001, J: 0.563) can estimate contralateral paratracheal metastasis with 60% sensitivity and 96.3% specificity. Conclusion In patients with lateral metastases, the rate of ipsilateralparatracheal metastasis is 85%, while the rate of contralateral paratracheal metastasis is 35.7%. The number of ipsilateral central region or pretracheal lymph node metastases may be helpful in predicting contralateral paratracheal lymph node metastases. Notably, unilateral CND may be performed in the presence of ≤ 2 metastases in the ipsilateral central region.
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Affiliation(s)
- Isik Cetinoglu
- Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Nurcihan Aygun
- Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Ceylan Yanar
- Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Ozan Caliskan
- Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Mehmet Kostek
- Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Mehmet Taner Unlu
- Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Mehmet Uludag
- Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
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Chotigavanich C, Ongard S, Metheetrairut C, Wongsuwan P, Sureepong P. Central Neck Lymph Node Size Measured by Ultrasound Significantly Predicts Central Neck Lymph Node Metastasis of Papillary Thyroid Carcinoma. EAR, NOSE & THROAT JOURNAL 2023:1455613231215039. [PMID: 38099484 DOI: 10.1177/01455613231215039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
Objective: The aim of this study was to investigate whether Central lymph node (CLN) size as measured by an ultrasound can significantly predict CLN metastasis of papillary thyroid carcinoma (PTC). Materials and methods: This retrospective chart review of patients diagnosed with PTC who underwent ultrasound and central neck dissection (CND). We excluded patients who received previous thyroid surgery or radiation. We analyzed the correlation between CLN size and characteristics by ultrasound and histopathologic findings among positive CLN patients. Results: Of the 48 patients who underwent preoperative ultrasound and CND, 34 patients had positive CLN identified by ultrasound. The positive predictive value, negative predictive value, sensitivity, specificity, and accuracy of ultrasound in this diagnostic setting was 88.0%, 21.0%, 73.2%, 42.9%, and 68.7%, respectively. The risk of CLN metastasis of PTC was 67.7% and 85.7% for lymph node size 3.1 to 4 mm and 4.1 to 5 mm, respectively. The risk increased to 100% when the lymph node size was >5 mm. Positive preoperative ultrasound of lateral neck lymph node was found to be a significant risk factor for CLN metastasis (P = .003). Conclusion: Ultrasound was found to be an effective preoperative evaluation in patients with PTC to determine the likelihood of CLN metastasis and whether CND is indicated, especially in the ultrasound-positive central lymph node. A high risk of metastasis was found in CLN size >3 mm by ultrasound, and the risk dramatically increased in CLN size >5 mm. We also found positive lateral neck node from preoperative ultrasound to be a significant risk factor for CLN metastasis.
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Affiliation(s)
- Chanticha Chotigavanich
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sunun Ongard
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Choakchai Metheetrairut
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pranruetai Wongsuwan
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Paiboon Sureepong
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Zhao M, Shi X, Zou Z, Wen R, Lu Y, Li J, Cao J, Zhang B. Predicting skip metastasis in lateral lymph nodes of papillary thyroid carcinoma based on clinical and ultrasound features. Front Endocrinol (Lausanne) 2023; 14:1151505. [PMID: 37229457 PMCID: PMC10203516 DOI: 10.3389/fendo.2023.1151505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/14/2023] [Indexed: 05/27/2023] Open
Abstract
Background Skip metastasis in papillary thyroid cancer (PTC), defined as lateral lymph node metastasis (LLNM) without the involvement of central lymph node metastasis (CLNM), is generally unpredictable. Our study aimed to develop a model to predict skip metastasis by using clinicopathological and ultrasound factors of PTC. Methods We retrospectively reviewed the medical records of patients who underwent total thyroidectomy and central lymph node dissection (CLND) plus lateral lymph node dissection (LLND) between January 2019 and December 2021 at the First Affiliated Hospital of Soochow University. Furthermore, univariate and multivariate analyses assessed the clinical and ultrasound risk factors. Receiver operating characteristic (ROC) curves were used to find the optimal cut-off values for age and dominant nodule diameter. Multivariate logistic regression analysis results were used to construct a nomogram and were validated internally. Results In all patients, the skip metastasis rate was 15.4% (41/267). Skip metastasis was more frequently found in patients with a tumour size ≤10 mm (OR 0.439; P = 0.033), upper tumour location (OR 3.050; P=0.006) and fewer CLNDs (OR 0.870; P = 0.005). After analysing the clinical and ultrasound characteristics of the tumour, five factors were ultimately associated with lateral lymph node skip metastasis and were used to construct the model. These factors were an age >40 years, tumour diameter <9.1 mm, upper tumour location, non-smooth margin and extrathyroidal extension. The internally evaluated calibration curves indicated an excellent correlation between the projected and actual skip metastasis probability. The nomogram performed well in discrimination, with a concordance index of 0.797 (95% CI, 0.726 to 0.867). Conclusions This study screened for predictors of skip metastasis in PTC and established a nomogram that effectively predicted the risk of potential skip metastasis in patients preoperatively. The method can predict and distinguish skip metastases in PTC in a simple and inexpensive manner, and it may have future therapeutic utility.
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Affiliation(s)
- Min Zhao
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xinyu Shi
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ziran Zou
- Department of Ultrasound, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Runze Wen
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yixing Lu
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jihui Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jinming Cao
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
- State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China
| | - Bin Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
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Mechera R, Maréchal-Ross I, Sidhu SB, Campbell P, Sywak MS. A Nod to the Nodes: An Overview of the Role of Central Neck Dissection in the Management of Papillary Thyroid Carcinoma. Surg Oncol Clin N Am 2023; 32:383-398. [PMID: 36925192 DOI: 10.1016/j.soc.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Lymph node metastasis in thyroid cancer is common and associated with an increased risk of locoregional recurrence (LRR). Although therapeutic central neck dissection is well established, prophylactic central node dissection (pCND) for microscopic occult nodal involvement is controversial and recommendations are based on low-level evidence. The potential benefits of pCND such as reducing LRR and re-operation, refining staging, and improving surveillance are enthusiastically debated and the decision to perform pCND must be weighed up against the increased risks of complications.
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Affiliation(s)
- Robert Mechera
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, St. Leonards, New South Wales 2065, Australia; Clarunis, University Hospital Basel, Spitalstrasse 21, Basel 4031, Switzerland; Endocrine and Breast Surgery, St. George Hospital, Gray Street, Kogarah, New South Wales 2217, Australia.
| | - Isabella Maréchal-Ross
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, St. Leonards, New South Wales 2065, Australia
| | - Stan B Sidhu
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, St. Leonards, New South Wales 2065, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales 2006, Australia
| | - Peter Campbell
- Endocrine and Breast Surgery, St. George Hospital, Gray Street, Kogarah, New South Wales 2217, Australia
| | - Mark S Sywak
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, St. Leonards, New South Wales 2065, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales 2006, Australia
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8
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Wu X, Li B, Zheng C, He X. Risk factors for skip metastasis in patients with papillary thyroid microcarcinoma. Cancer Med 2022; 12:7560-7566. [PMID: 36479912 PMCID: PMC10067130 DOI: 10.1002/cam4.5507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 07/19/2022] [Accepted: 11/19/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Lymph node metastasis (LNM) is prevalent in papillary thyroid microcarcinoma (PTMC) and is essential when determining tumor stage and prognosis. Positive lateral LNM with negative central LNM is defined as skip metastasis. Thyroid carcinoma's risk factors for skip metastasis remain controversial, especially in PTMC. This study aimed to determine the clinical features as well as the risk factors of skip metastasis among patients with PTMC. METHODS We conducted retrospective research among patients with PTMC who were subjected to treatment at our Hospital between January 2018 and December 2019 by reviewing their medical records. A database containing demographic characteristics, ultrasonography features, blood test outcomes, operation information, pathology details, and follow-up information was constructed. The link between skip metastasis and clinicopathological features of PTMC was evaluated using univariate as well as multivariate analyses. RESULTS Overall, 293 patients diagnosed with PTMC and lateral LNM were included. There were 91 men (31.1%) and 202 women (68.9%). The median age was 38 (31-47) years. Fifty patients were diagnosed with skip metastases. Levels III and II + III were the most prevalent in single-level and two-level metastasis, correspondingly. Univariate and multivariate analyses detected two independent factors linked to skip metastasis in PTMC: female sex (odds ratio = 2.609, 95% confidence interval (CI): 1.135-6.000; p = 0.024) and location of the tumor (upper portion) (odds ratio = 2.959, 95% CI: 1.552-5.639; p = 0.001). CONCLUSIONS Skip metastasis is prevalent in thyroid carcinoma. Female sex and tumor location (upper portion) are independently linked to skip metastasis in PTMC. Patients who have these two risk factors should undergo a meticulous preoperative and intraoperative evaluation of lymph node status.
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Affiliation(s)
- Xin Wu
- Department of General Surgery Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Binglu Li
- Department of General Surgery Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Chaoji Zheng
- Department of General Surgery Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Xiaodong He
- Department of General Surgery Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
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Bertin JB, Buffet C, Leenhardt L, Menegaux F, Chereau N. Effect of skip metastasis to lateral neck lymph nodes on outcome of patients with papillary thyroid carcinoma. Langenbecks Arch Surg 2022; 407:3025-3030. [PMID: 35819485 DOI: 10.1007/s00423-022-02604-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/03/2022] [Indexed: 11/26/2022]
Abstract
CONTEXT Lymph node metastasis (N1) is a prognostic factor for disease recurrence in papillary thyroid carcinoma (PTC) patients. Skip metastasis is defined as only lateral N1 with negative central lymph nodes (LNs). OBJECTIVE The aim of this study was to explore the outcome of PTC patients with skip N1. PATIENTS AND DESIGN All patients who underwent a total thyroidectomy with ipsilateral central and lateral LN dissection for PTC from 1999 to 2019 in a high-volume endocrine surgery centre were included in this study. MAIN OUTCOME MEASURE Demographic and outcomes-recurrence and disease-specific survival (DSS)-were compared between three groups: N1a (central N1 only), N1b-CL (central and lateral N1), and N1b-Skip (lateral N1 without central LN involvement). RESULTS During the study period, 3046 patients had surgery for PTC, including 1138 with N1 (37%, 860 women, mean age: 44.8 years) comprising 474 N1a (42%), 513 N1b-CL (45%), and 151 N1b-Skip (13%). The median follow-up was 74 months (range 12-216 months). The recurrence rate in the N1b-Skip group was 13% (20/151) and 10% (47/474) in the N1a group. This was significantly lower than that in the N1b-CL group (27%, 140/513) (p < 0.0001). DSS at 10 years was 99% for group N1a, 98% for the N1b-CL, and 99% in the N1b-Skip group. CONCLUSION The recurrence rate of N1b-Skip patients was lower than that of N1b-CL patients and similar to that of N1a patients. This result could be used as an indication for the modality of radioiodine therapy, and for the pattern of follow-up procedures.
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Affiliation(s)
- Jean Baptiste Bertin
- Department of General and Endocrine Surgery, Pitié Salpêtrière Hospital, APHP, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Camille Buffet
- Thyroid and Endocrine Tumor Unit, Pitié Salpêtrière Hospital, APHP, Sorbonne University, Paris, France
- Groupe de Recherche Clinique N°16 Thyroid Tumors, Sorbonne University, Paris, France
| | - Laurence Leenhardt
- Thyroid and Endocrine Tumor Unit, Pitié Salpêtrière Hospital, APHP, Sorbonne University, Paris, France
- Groupe de Recherche Clinique N°16 Thyroid Tumors, Sorbonne University, Paris, France
| | - Fabrice Menegaux
- Department of General and Endocrine Surgery, Pitié Salpêtrière Hospital, APHP, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
- Groupe de Recherche Clinique N°16 Thyroid Tumors, Sorbonne University, Paris, France
| | - Nathalie Chereau
- Department of General and Endocrine Surgery, Pitié Salpêtrière Hospital, APHP, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
- Groupe de Recherche Clinique N°16 Thyroid Tumors, Sorbonne University, Paris, France.
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Weng HY, Yan T, Qiu WW, Fan YB, Yang ZL. The Prognosis of Skip Metastasis in Papillary Thyroid Microcarcinoma Is Better Than That of Continuous Metastasis. J Clin Endocrinol Metab 2022; 107:1589-1598. [PMID: 35213704 DOI: 10.1210/clinem/dgac107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Indexed: 12/21/2022]
Abstract
CONTEXT A few papillary thyroid microcarcinomas (PTMCs) may have skip metastasis (SLNM), but the risk factors remain controversial and the prognosis is unclear. OBJECTIVES To investigate the incidence, lymph node metastasis (LNM) patterns, risk factors, and prognosis of SLNM in PTMCs. METHODS We reviewed the medical records of PTMC patients who underwent thyroid surgery in our institution. Analyses of risk factors were performed for SLNM. Recurrence-free survival (RFS) of SLNM, central lymph node metastasis (CLNM), and continuous metastasis (CLNM and lateral lymph node metastasis [CLNM + LLNM]) were compared after propensity score matching (PSM). RESULTS SLNM was detected in 1.7% (50/3923) and frequently involved level III (66.7%). Compared with CLNM + LLNM, SLNM had more LNM at a single level (P < 0.01) and less LNM at 2 levels (P < 0.05). A tumor size of 0.5 to 1 cm (odds ratio [OR], 2.26; 95% CI, 1.27-4.00) and location in the upper pole (OR, 3.30; 95% CI, 2.02-5.40) were independent risk factors for SLNM. A total of 910 (23.2%) PTMCs with LNM were included in the prognostic analysis. At a median follow-up of 60 months, the RFS of SLNM did not differ from that of CLNM (P = 0.10) but was significantly higher than that of CLNM + LLNM (P < 0.01) after using PSM. CONCLUSIONS When the tumor size is 0.5 to 1 cm or its location is in the upper pole, we must remain vigilant to SLNM in PTMC. Because its prognosis is comparable to that of only CLNM and better than that of CLNM + LLNM, less intensive treatment should be considered.
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Affiliation(s)
- Huai-Yu Weng
- Department of Thyroid, Parathyroid, Breast and Hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Ting Yan
- Department of Thyroid, Parathyroid, Breast and Hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Wang-Wang Qiu
- Department of Thyroid, Parathyroid, Breast and Hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - You-Ben Fan
- Department of Thyroid, Parathyroid, Breast and Hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Zhi-Li Yang
- Department of Thyroid, Parathyroid, Breast and Hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
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Role and Extent of Neck Dissection for Neck Lymph Node Metastases in Differentiated Thyroid Cancers. SISLI ETFAL HASTANESI TIP BULTENI 2022; 55:438-449. [PMID: 35317376 PMCID: PMC8907697 DOI: 10.14744/semb.2021.76836] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 11/20/2022]
Abstract
Differentiated thyroid cancers (DTC) consist of 95% of thyroid tumors and include papillary thyroid cancer (PTC), follicular thyroid cancer (FTC), and Hurthle cell thyroid cancer (HTC). Rates of lymph node metastases are different depending on histologic subtypes and <5% in FTC and between 5% and 13% in HTC. Lymph node metastasis is more frequent in PTC and while rate of clinical metastasis can be seen approximately 30% rate of routine micrometastasis can be seen up to 80%. Lymph node metastasis of DTC mostly develops first in the Level VI lymph nodes at the central compartment starting from the ipsilateral paratracheal lymph nodes and then spreading to the contralateral paratracheal lymph nodes. Spread to the Level VII is mostly after Level VI invasion. Subsequent spread is to the lateral neck compartments of Levels IV, III, IIA, and VB and sometimes to the Levels IIB and VA. Occasionally skip metastasis to the lateral neck compartments develop without spreading to the central compartments and this situation is more frequent in upper pole tumors. Although application of prophylactic central neck dissection (pCND) in DTC increases the rate of complication, due to its unclear effects on oncologic results and quality of life, the interest to the pCND is decreasing and debate on its surgical extent is increasing. pCND is not essential in DTC and characteristics of patient and tumor and experience of surgeon should be considered when deciding for pCND. Due to lower complication rate of one sided pCND compared to bilateral central neck dissection (CND), low possibility of contralateral central neck metastasis and low risk of recurrence, application of one-sided CND is logical. Although therapeutic CND (tCND) is the standart treatment when there is a clinically involved lymph node, extent of dissection is a matter of debate. A case-based decision for the extent of tCND can be made by considering patient and tumor characteristics and experience of the surgeon. Due to the higher complication risk of bilateral CND, unilateral tCND can be performed if there is no suspicious lymph node on the contralateral side and bilateral tCND can be applied when there is a suspicion for metastasis only on the contralateral side or there are features for risk of metastasis to the contralateral side. In patients with clinical central metastasis owing to intra-operative pathology results by frozen section procedure are compatible with post-operative pathology results, when there is a suspicion for contralateral metastasis, a decision for one- or two-sided dissection can be made using frozen section procedure. In DTC, it can be stated that there is a consensus in the literature about not performing prophylactic lateral neck dissection (LND), but performing therapeutic LND (tLND). In addition, there is a debate on the extent of tLND. In a meta-analysis about lateral metastasis, the rates of metastasis to the Levels IIA, IIB, III, IV, VA, and VB were 53.1%, 15.5%, 70.5%, 66.3%, 7.9%, and 21.5%, respectively. Ultrasonography (USG) is an effective procedure for detection of cervical nodal metastasis on lateral compartment. Pre-operative imaging with USG and/or combination with the fine needle aspiration biopsy (cytology/molecular test/Thyroglobulin test) can allow pre-operative detection and verification of lateral lymph node metastasis. Extent of tLND can be determined to minimize morbidity considering pre-operative USG findings, pre-operative tumor and clinical features of lateral metastasis. Especially in the presence of limited lateral metastases, limited selective LND such as Levels III, IV or Levels IIA, III, IV can be applied according to the patient. Levels IIB and VB should be added to the dissection in the presence of metastases in these regions. In cases that increase the risk of Level IIB involvement, such as presence of metastasis at Level IIA, extranodal tumor involvement, presence of multifocal tumor, and in cases that increase the risk of Level VB involvement such as macroscopic extranodal spread, and simultaneous metastases at Levels II, III, IV; Levels IIB and VB can be added to dissection material. Levels I and VA should be added to the dissection in the presence of clinically detected metastases.
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12
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Zhao L, Wu F, Zhou T, Lu K, Jiang K, Zhang Y, Luo D. Risk factors of skip lateral cervical lymph node metastasis in papillary thyroid carcinoma: a systematic review and meta-analysis. Endocrine 2022; 75:351-359. [PMID: 35067901 DOI: 10.1007/s12020-021-02967-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/11/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To analyze and explore the risk factors of skip lateral cervical lymph node metastasis (SLLNM) in papillary thyroid carcinoma (PTC). METHODS PubMed, Web of Science, Embase, Cochrane, Wanfang, China National Knowledge Infrastructure, and China Science and Technology Journal databases, updated to April 4, 2021, were systematically searched for literature on the risk factors of SLLNM in PTC. The meta-analysis was completed using Stata 15.0 software after quality evaluation. The odds ratio (OR) and 95% confidence interval (CI) of each variable were calculated using fixed or random-effects models, and the publication bias was evaluated by the Egger's test. RESULTS A total of 28 studies with 10,682 cases were included in our meta-analysis; 1592 (14.90%) cases were positive for SLLNM. The meta-analysis showed that female sex (OR = 1.16, 95% CI = 1.02-1.31, P = 0.021), age ≥45 (OR = 1.60, 95% CI = 1.19-2.15, P = 0.002), tumor diameter ≤10 mm (OR = 2.23, 95% CI = 1.62-3.06, P < 0.001), and upper location of tumor (OR = 3.60, 95% CI = 2.65-4.89, P < 0.001) were risk factors for SLLNM in PTC patients. Hashimoto's thyroiditis (OR = 1.02, 95% CI = 0.88-1.19, P = 0.777), multifocality (OR = 0.98, 95% CI = 0.75-1.28, P = 0.873), bilateral tumors (OR = 0.92, 95% CI = 0.70-1.19, P = 0.515), extrathyroidal extensions (OR = 1.07, 95% CI = 0.83-1.39, P = 0.598), and capsular invasion (OR = 0.93, 95% CI = 0.65-1.31, P = 0.660) were not closely related to SLLNM risk. CONCLUSION This study confirmed significant associations between SLLNM and female sex, age ≥45, tumor diameter ≤10 mm, and upper location of the tumor.
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Affiliation(s)
- Lingqian Zhao
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Fan Wu
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Tianhan Zhou
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Kaining Lu
- Department of Surgical Oncology, Affiliated Hangzhou First People's Hospital Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Kecheng Jiang
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Yu Zhang
- Department of Surgical Oncology, Affiliated Hangzhou First People's Hospital Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Dingcun Luo
- Department of Surgical Oncology, Affiliated Hangzhou First People's Hospital Zhejiang University School of Medicine, Hangzhou, 310006, China.
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13
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Hu Q, Zhang WJ, Liang L, Li LL, Yin W, Su QL, Lin FF. Establishing a Predictive Nomogram for Cervical Lymph Node Metastasis in Patients With Papillary Thyroid Carcinoma. Front Oncol 2022; 11:766650. [PMID: 35127475 PMCID: PMC8809373 DOI: 10.3389/fonc.2021.766650] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 12/27/2021] [Indexed: 01/21/2023] Open
Abstract
Objectives The purpose of this study was to establish a nomogram for predicting cervical lymph node metastasis (CLNM) in patients with papillary thyroid carcinoma (PTC). Materials and Methods A total of 418 patients with papillary thyroid carcinoma undergoing total thyroidectomy with cervical lymph node dissection were enrolled in the retrospective study from January 2016 to September 2019. Univariate and multivariate Logistic regression analysis were performed to screen the clinicopathologic, laboratory and ultrasound (US) parameters influencing cervical lymph nodes metastasis and develop the predicting model. Results CLNM was proved in 34.4% (144/418) of patients. In the multivariate regression analysis, Male, Age < 45 years, Tumor size > 20mm, multifocality, ambiguous boundary, extracapsular invasion and US-suggested lymph nodes metastasis were independent risk factors of CLNM (p < 0.05). Prediction nomogram showed an excellent discriminative ability, with a C-index of 0.940 (95% confidence interval [CI], 0.888-0.991), and a good calibration. Conclusion The established nomogram showed a good prediction of CLNM in patients with PTC. It is conveniently used and should be considered in the determination of surgical procedures.
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Affiliation(s)
- Qiao Hu
- Department of Ultrasound, The People’s Hospital of Guangxi Zhuang Autonomous Region & Guangxi Academy of Medical Sciences, Nanning, China
- *Correspondence: Qiao Hu,
| | - Wang-Jian Zhang
- School of Public Health, Sun Yet-Sen University, Guangzhou, China
| | - Li Liang
- Department of Ultrasound, The People’s Hospital of Guangxi Zhuang Autonomous Region & Guangxi Academy of Medical Sciences, Nanning, China
| | - Ling-Ling Li
- Department of Ultrasound, The People’s Hospital of Guangxi Zhuang Autonomous Region & Guangxi Academy of Medical Sciences, Nanning, China
| | - Wu Yin
- Department of Pathology, The People’s Hospital of Guangxi Zhuang Autonomous Region & Guangxi Academy of Medical Sciences, Nanning, China
| | - Quan-Li Su
- Department of Ultrasound, The People’s Hospital of Guangxi Zhuang Autonomous Region & Guangxi Academy of Medical Sciences, Nanning, China
| | - Fei-Fei Lin
- Department of Ultrasound, The People’s Hospital of Guangxi Zhuang Autonomous Region & Guangxi Academy of Medical Sciences, Nanning, China
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14
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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+).
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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.)
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15
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Wang Y, Deng C, Shu X, Yu P, Wang H, Su X, Tan J. Risk Factors and a Prediction Model of Lateral Lymph Node Metastasis in CN0 Papillary Thyroid Carcinoma Patients With 1-2 Central Lymph Node Metastases. Front Endocrinol (Lausanne) 2021; 12:716728. [PMID: 34721289 PMCID: PMC8555630 DOI: 10.3389/fendo.2021.716728] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/23/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Papillary 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). METHODS We 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. RESULTS In 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. CONCLUSIONS For 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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Affiliation(s)
- Yuanyuan Wang
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chang Deng
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiujie Shu
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ping Yu
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huaqiang Wang
- Department of Hepatobiliary, Breast and Thyroid Surgery, The People’s Hospital of Nanchuan, Chongqing, China
| | - Xinliang Su
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Xinliang Su, ; Jinxiang Tan,
| | - Jinxiang Tan
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Xinliang Su, ; Jinxiang Tan,
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16
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Yang Z, Heng Y, Zhao Q, Cao Z, Tao L, Qiu W, Cai W. A Specific Predicting Model for Screening Skip Metastasis From Patients With Negative Central Lymph Nodes Metastasis in Papillary Thyroid Cancer. Front Endocrinol (Lausanne) 2021; 12:743900. [PMID: 34659126 PMCID: PMC8515125 DOI: 10.3389/fendo.2021.743900] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/08/2021] [Indexed: 12/19/2022] Open
Abstract
Skip metastasis is a specific type of papillary thyroid cancer lymph node metastasis (LNM). The present study aimed to clarify the typical clinical characteristics of skip metastasis and optimize the prediction model, so as to provide a more individual treatment mode for skip metastasis. We retrospectively analyzed 1075 PTC patients with different lymph node metastasis statuses from two clinical centers. Comparisons have been made between patients with skip metastasis and other types of LNM. Univariate and multivariate analyses were performed to detect the risk factors for skip metastasis with negative LNM, and a nomogram for predicting skip metastasis was established. The rate of skip metastasis was 3.4% (37/1075). Compared with other types of LNM, significant differences showed in tumor size, upper portion location, thyroid capsular invasion, and ipsilateral nodular goiter with the central lymph node metastasis (CLNM) group, and in age and gender with the lateral lymph node metastasis (LLNM) group. Four variables were found to be significantly associated with skip metastasis and were used to construct the model: thyroid capsular invasion, multifocality, tumor size > 1 cm, and upper portion. The nomogram had good discrimination with a concordance index of 0.886 (95% confidence interval [CI], 0.823 to 0.948). In conclusion, the significant differences between skip metastasis and other types of LNM indicated that the lymph node drainage pathway of skip metastasis is different from either CLNM or LLNM. Furthermore, we established a nomogram for predicting risk of skip metastasis, which was able to effectively predict the potential risk of skip metastasis in patients without preoperative LNM clue.
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Affiliation(s)
- Zheyu Yang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Heng
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Qiwu Zhao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zichao Cao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Tao
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- *Correspondence: Wei Cai, ; Weihua Qiu, ; Lei Tao,
| | - Weihua Qiu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Wei Cai, ; Weihua Qiu, ; Lei Tao,
| | - Wei Cai
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Wei Cai, ; Weihua Qiu, ; Lei Tao,
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17
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Ishibashi-Kanno N, Yamagata K, Fukuzawa S, Uchida F, Yanagawa T, Bukawa H. Incidental cervical lymph node metastasis of papillary thyroid cancer in neck dissection specimens from a tongue squamous cell carcinoma patient: a case report. Oral Maxillofac Surg 2020; 25:127-132. [PMID: 32829459 DOI: 10.1007/s10006-020-00894-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/11/2020] [Indexed: 01/02/2023]
Abstract
We report a rare case of lymph node metastasis of papillary thyroid cancer (PTC) incidentally detected in a neck dissection specimen of tongue squamous cell carcinoma (SCC). A 42-year-old Japanese woman was diagnosed with tongue SCC (T1N0M0, Stage I). Partial glossectomy with supraomohyoid neck dissection was performed under general anesthesia, and histopathological examinations revealed primary SCC of the tongue and neck metastasis of PTC in neck dissection specimens. A few months later, total thyroidectomy and left modified radical neck dissection were performed by thyroid surgeons. The histopathological diagnosis was PTC of both the thyroid glands. There was no evidence of tumor recurrence or distant metastasis at the 9-month follow-up.
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Affiliation(s)
- Naomi Ishibashi-Kanno
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Kenji Yamagata
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
| | - Satoshi Fukuzawa
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
| | - Fumihiko Uchida
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
| | - Toru Yanagawa
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan.,Department of Oral and Maxillofacial Surgery, Ibaraki Prefectural Central Hospital, Koibuchi 6528, Kasama, Ibaraki, 309-1793, Japan
| | - Hiroki Bukawa
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
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Dou Y, Hu D, Chen Y, Xiong W, Xiao Q, Su X. PTC located in the upper pole is more prone to lateral lymph node metastasis and skip metastasis. World J Surg Oncol 2020; 18:188. [PMID: 32723382 PMCID: PMC7389816 DOI: 10.1186/s12957-020-01965-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/22/2020] [Indexed: 02/06/2023] Open
Abstract
Background Lateral lymph node metastasis (LLNM) is very common in papillary thyroid carcinoma (PTC). The influence of tumour location on LLNM remains controversial. The purpose of this study was to reveal the association between PTC tumours located in the upper pole and LLNM. Methods We reviewed a total of 1773 PTC patients who underwent total thyroidectomy with central and lateral lymph node dissection between 2013 and 2018. Patients were divided into two groups according to tumour location. Univariate and multivariate analyses were performed to identify risk factors associated with LLNM and “skip metastasis”. Results In the upper pole group, LLNM and skip metastasis were significantly likely to occur. Multivariate analysis showed that tumours located in the upper pole, male sex, extrathyroidal extension (ETE), central lymph node metastasis (CLNM) and tumour size were independent risk factors for LLNM, with odds ratios ([ORs], 95% confidence intervals [CIs]) of 2.136 (1.707–2.672), 1.486 (1.184–1.867), 1.332 (1.031–1.72), 4.172 (3.279–5.308) and 2.496 (1.844–3.380), respectively. Skip metastasis was significantly associated with the primary tumour location in the upper pole and age > 55 years, with ORs of 4.295 (2.885–6.395) and 2.354 (1.522–3.640), respectively. Conclusions In our opinion, papillary thyroid tumours located in the upper pole may have an exclusive drainage pathway to the lateral lymph nodes. When the tumour is located in the upper pole, lateral neck dissection should be evaluated meticulously.
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Affiliation(s)
- Yi Dou
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Daixing Hu
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yingji Chen
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Wei Xiong
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Qi Xiao
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xinliang Su
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Hou J, Zhang Y, Fan Y, Wu B. Risk factors of skip lateral lymph node metastasis in papillary thyroid carcinoma. Eur Arch Otorhinolaryngol 2020; 278:493-498. [PMID: 32607832 DOI: 10.1007/s00405-020-06176-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/26/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE Cervical lymph node metastasis is a prognostic factor of papillary thyroid carcinoma (PTC). This study aimed to investigate clinicopathological features and risk factors of skip lateral lymph node metastasis in PTC patients. METHODS We retrospectively reviewed medical records of patients who underwent simultaneous total thyroidectomy with therapeutic central compartment lymph node dissection (LND) and lateral LND for primary PTC from 2014 to 2019. Univariate and multivariate logistic regression analyses were performed to identify clinicopathologic risk factors for skip metastasis. Receiver-operating characteristic (ROC) curves were constructed using the results of the multiple logistic regression analysis to identify data points with the highest sensitivity and lowest false-negative rate. RESULTS The frequency of skip metastasis was approximately 12.8% (50/390). Multivariate logistic regression analysis showed that age (odds ratio [OR], 1.033; 95% confidence interval [CI], 1.008-1.059; P = 0.010), tumor size (OR 0.251; 95% CI 0.129-0.490; P < 0.001) and tumor located in the upper portion (OR 0.378; 95% CI 0.200-0.715; P = 0.003) were independent risk factors of skip metastasis (all P < 0.05). The ROC curves showed that the cut-off value of age for predicting skip metastasis was 44.5 years old (sensitivity = 0.620, specificity = 0.618, area under the curve [AUC] = 0.627, P = 0.004); the cut-off value of the tumor diameter for predicting skip metastasis was 1.05 cm (sensitivity = 0.503, specificity = 0.760, AUC = 0.682, P < 0.001). CONCLUSIONS Skip metastasis was common in PTC. The PTC patients with age > 44.5 years, tumor diameter < 1.05 cm and tumor located in the upper portion should be carefully evaluated for skip metastasis.
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Affiliation(s)
- Jianzhong Hou
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Yingchao Zhang
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Youben Fan
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Bo Wu
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
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