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Lee JK, Choi JH, Kim W, Kwak J, Yu HW, Kim SJ, Chai YJ, Choi JY, Lee KE. Bilateral axillo-breast approach robotic thyroidectomy in pediatric patients with thyroid disease and cancer. Endocrine 2023; 81:532-539. [PMID: 37171524 DOI: 10.1007/s12020-023-03372-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/08/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE Robotic thyroid surgeries have cosmetic advantages over open surgeries, which are especially important in pediatric patients due to social stigmas from neck scars. The present study describes outcomes in a series of children who underwent bilateral axillo-breast approach (BABA) robotic thyroidectomy. METHODS Pediatric patients aged ≤18 years who underwent BABA robotic thyroidectomy between 2014 and 2022 were retrospectively reviewed. Their clinical characteristics and surgical outcomes were evaluated. Surgical completeness was determined by comparing the number of retrieved lymph nodes per compartment to previously reported lymph node quantification. RESULTS This study included 26 pediatric patients of mean age 15.5 years (range, 5-18 years). Of these 26 patients, 21 (80.8%) had thyroid cancer, with 9 (42.9%) having aggressive tumor pathology. The mean operation time was 157.3 min. No patient needed open conversion. Five patients (19.2%) experienced complications including transient hypoparathyroidism (n = 5), permanent hypoparathyroidism (n = 2), and chyle leakage (n = 1), but none experienced vocal cord palsy. The mean numbers of retrieved lymph nodes at levels IIa, III, IV, Vb, and VI were 3.2, 4.1, 5.6, 1.0, and 9.7, respectively, numbers comparable with the known quantification except for level II, as IIb dissection was omitted in our series. CONCLUSION BABA robotic thyroidectomy is safe and effective in pediatric patients with thyroid diseases. Most complications were minor and transient, with the operation time similar to robotic thyroidectomy in adults. Surgical completeness was also satisfactory. Robotic thyroidectomy can be considered a surgical option, regardless of patient age or diagnosis.
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Affiliation(s)
- Ja Kyung Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jee-Hye Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Surgery, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, NY, USA
| | - Woochul Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - JungHak Kwak
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Hyeong Won Yu
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Su-Jin Kim
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Young Jun Chai
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Battoo AJ, Sheikh ZA, Nisar J, Thankappan K, Kuriakose MA, Haji AG. Extended Level IV Neck Dissection for Limited Prophylactic Clearance of Level V in Node-Positive Papillary Thyroid Carcinoma: a Homogenous Study Population. Indian J Surg Oncol 2023; 14:345-353. [PMID: 37324295 PMCID: PMC10267089 DOI: 10.1007/s13193-020-01167-7] [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: 03/05/2020] [Accepted: 07/07/2020] [Indexed: 11/26/2022] Open
Abstract
There is near consensus that prophylactic lateral neck dissection has no role in the management of differentiated thyroid cancer, but the extent of lateral neck dissection in differentiated thyroid cancer remains controversial, especially whether level V should be addressed or not. There is lot of heterogeneity in reporting of the management of level V in papillary thyroid cancer. We at our Institute address the lateral neck positive papillary thyroid cancer with selective neck dissection involving levels II-IV, performing extended level IV dissection with inclusion of the triangular area delineated by the sternocleidomastoid muscle, the clavicle, and the perpendicular line drawn to the clavicle from the point where the horizontal line at the level of cricoid cuts the posterior border of sternocleidomastoid muscle. Retrospective analysis of the departmental data set related to thyroidectomy with lateral neck dissection from 2013 to mid-2019 for papillary thyroid cancer, was carried out. Patients with recurrent papillary thyroid cancer were excluded as were patients with involvement of level V. Data related to the demography of patients, histological diagnosis, and postoperative complications were compiled and summarized. Note was made of the incidence of ipsilateral neck recurrence and the neck level involved with recurrence noted. Data was analyzed for fifty-two patients of non-recurrent papillary thyroid cancer who had undergone total thyroidectomy and lateral neck dissection involving levels II-IV, with extended dissection at level IV. It should be noted that none of the patients had clinical involvement of level V. Only two patients had lateral neck recurrence, both the recurrences were in level III, one on the ipsilateral side and the other on the contralateral side. Recurrence in the central compartment was noted in two patients, with one of these patients also having ipsilateral level III recurrence. One of the patients had distal metastasis to the lungs. Transient paresis of the unilateral vocal cords was noted in seven patients which got resolved within 2 months in all of them. Transient hypocalcemia was noted in four patients. Although our series has a small sample size with limited follow-up, it is one of the few studies in which prophylactic level V dissection has been studied in a homogenous study population of non-recurrent papillary thyroid cancer. Our study has shown that prophylactic dissection of level V may have a limited role, but further large multi-institutional studies need to be carried out to come up with a definite answer.
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Affiliation(s)
- Azhar Jan Battoo
- Sher i Kashmir Institute of Medical Sciences, Srinagar, 190011 India
| | | | - Jasif Nisar
- Sher i Kashmir Institute of Medical Sciences, Srinagar, 190011 India
| | | | - Moni Abraham Kuriakose
- Cochin Cancer Research Centre, Kochi, Kerala 683503 India
- Roswell Park Cancer Institute, Elm & Carlton Streets Buffalo, Buffalo, NY 14263 USA
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Kang JG, Choi JE, Kang SH. Risk factors for level V metastasis in patients with N1b papillary thyroid cancer. World J Surg Oncol 2022; 20:327. [PMID: 36180912 PMCID: PMC9524026 DOI: 10.1186/s12957-022-02782-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, and its incidence has increased. Lateral lymph node metastasis (LLNM) implies a worse prognosis than central lymph node metastasis, with a higher recurrence rate and decreased disease-free survival. The 2015 American Thyroid Association guidelines recommend compartmental node dissection in patients with LLNM to reduce the risk of recurrence and mortality. The purpose of this study was to identify the risk factors for level V lymph node (LN) metastasis in patients with N1b papillary thyroid cancer (PTC). METHODS A total of 110 consecutive patients who underwent total thyroidectomy with lateral neck dissection for PTC between April 2016 and April 2022 were retrospectively enrolled. Based on level V metastasis, 94 patients were divided into two groups, and their clinicopathological characteristics were compared. Univariable analysis were used to assess the factors associated with level V metastasis. Spearman correlation analysis were used to assess the correlation between tumors and LN. The receiver operating characteristic (ROC) curve was used to determine the optimal cutoff value for the number of metastatic LNs at each level for level V metastasis. RESULTS The number of metastatic LNs and lymph node ratio (LNR) in level II were significantly associated with level V metastasis (P = 0.011 and 0.001, respectively). The number of metastatic LNs in level II and those in the total number of levels correlated with the number of metastatic LNs in level V (rho = 0.331, 0.325, and P = 0.001, 0.001, respectively). The cutoff value for the number of metastatic LNs in level II was defined as 2.5 (area under the curve = 0.757, sensitivity = 50%, specificity = 82.5%, 95% confidence interval [CI] 0.626-0.889, P = 0.002). Simultaneous 3-level metastasis (level II, III, and IV) and 3-level with ≥ 2.5 metastatic LNs in level II were significantly associated with level V metastasis (P = 0.003 and 0.002). CONCLUSIONS The number of metastatic LNs and LNR in level II, simultaneous 3-level metastasis (level II, III, and IV), and 3-level with ≥ 2.5 metastatic LNs in level II were significantly associated with level V metastasis. (P = 0.011, 0.001, 0.003, and 0.002, respectively). In the future, larger-scale multi-institutional studies were needed to find out predictors for level V metastasis.
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Affiliation(s)
- Jin Gu Kang
- Department of Surgery, Yeungnam University College of Medicine, 170 Hyunchoong-ro, Namgu, Daegu, 42415, South Korea
| | - Jung Eun Choi
- Department of Surgery, Yeungnam University College of Medicine, 170 Hyunchoong-ro, Namgu, Daegu, 42415, South Korea
| | - Su Hwan Kang
- Department of Surgery, Yeungnam University College of Medicine, 170 Hyunchoong-ro, Namgu, Daegu, 42415, South Korea.
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Relevance of level IIb neck dissection in patients with papillary thyroid carcinoma. The Journal of Laryngology & Otology 2021; 135:269-272. [PMID: 33618782 DOI: 10.1017/s0022215121000499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cervical nodal metastasis is a key prognostic factor in patients with papillary thyroid carcinoma. The role of lymph nodes in papillary thyroid carcinoma management and prognosis remains controversial. METHODS Level IIb lymph nodes obtained from 44 patients with papillary thyroid carcinoma were histopathologically examined retrospectively. Specimens were classified as ipsilateral or contralateral. The number of dissected nodes and prevalence of level IIb metastasis were compared according to pre-operative clinical nodal stage. RESULTS In the node-negative neck, the prevalence of contralateral and ipsilateral IIb nodes was 0 out of 20 and 0 out of 3, respectively. In the node-positive neck, the prevalence of contralateral and ipsilateral IIb nodes was 1 out of 13 (7.70 per cent) and 3 out of 41 (7.32 per cent), respectively. Clinically determined and pathologically confirmed level IIb node negativity were significantly associated. Thirty-four patients (77.3 per cent) developed accessory nerve complications from level IIb dissection. CONCLUSION Level IIb neck dissection for papillary thyroid carcinoma may be required if pre-operative examination reveals multilevel, level IIa or suspicious level IIb metastasis.
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Prstačić R, Bumber B, Marjanović Kavanagh M, Jurlina M, Ivković I, Prgomet D. Metastasis predictors for neck sublevel IIb in papillary thyroid carcinoma. Clin Otolaryngol 2020; 45:710-717. [PMID: 32362059 DOI: 10.1111/coa.13562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/11/2020] [Accepted: 04/26/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To investigate possible metastasis predictors for neck sublevel IIb in papillary thyroid carcinoma (PTC) with lateral neck metastasis and to determine the reliability of preoperative ultrasound-guided fine-needle aspiration biopsy (FNAB) as a method of detecting positive lymph nodes in sublevel IIa in comparison with the finding of definitive pathohistological analysis. DESIGN Prospective study with patients with proven lateral neck metastases from PTC at the time of initial diagnosis. All patients had total thyroidectomy, central neck dissection (level VI) and selective neck dissection (levels II-V). Potential predictive factors for the occurrence of metastasis in sublevel IIb were analysed. Sensitivity and specificity tests were used to determine the reliability of preoperative ultrasound-guided FNAB. Patients were monitored for recurrence for at least ten years. SETTING Single-centre study. PARTICIPANTS Study included 53 patients with proven lateral neck metastases from PTC at the time of initial diagnosis. RESULTS Predictive factors for the occurrence of metastasis in sublevel IIb that have reached statistical significance are positive sublevel IIa, number of positive lymph nodes and positive levels IIa + III + IV + V. None of the patients who fulfilled predefined criterion for minimum 10-year follow-up had local recurrence in operated lateral levels. CONCLUSION Highest clinical significance has positivity of sublevel IIa. Therefore, it is necessary to prove or exclude metastasis in sublevel IIa, preoperatively or intraoperatively, to decide whether to include sublevel IIb in dissection. Preoperative ultrasound-guided FNAB is a reliable method for the detection of positive lymph nodes in sublevel IIa in comparison with the definitive histopathological analysis.
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Affiliation(s)
- Ratko Prstačić
- Department of Otorhinolaryngology-Head & Neck Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Boris Bumber
- Department of Otorhinolaryngology-Head & Neck Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marcel Marjanović Kavanagh
- Department of Otorhinolaryngology-Head & Neck Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Martin Jurlina
- Department of Otorhinolaryngology-Head & Neck Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Irena Ivković
- Department of Otorhinolaryngology-Head & Neck Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Drago Prgomet
- Department of Otorhinolaryngology-Head & Neck Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
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Liu Z, Liu Y, Fan Y, Wang X, Lu X. Level IIb lymph node metastasis characteristics and predictive factors for patients with cN1b papillary thyroid carcinoma. Surgery 2020; 167:962-968. [PMID: 32178864 DOI: 10.1016/j.surg.2020.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/01/2020] [Accepted: 02/04/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND The aim of the present study was to examine the frequency, characteristics, and risk factors of level IIb lymph node metastases in papillary thyroid carcinoma. METHODS We reviewed and collected clinical and pathological records for 954 papillary thyroid carcinoma patients with clinically positive lateral neck node metastasis. Univariate and multivariate analyses were performed to detect risk factors for level IIb lymph node metastasis; a predictive model was built based on multivariate analysis and tested in a validation group. RESULTS Level IIb lymph node metastasis was observed in 137 of 954 patients (14.4%). Univariate and multivariate analyses using the training group indicated that gross extrathyroidal extension of the primary tumor, tumor location in the upper pole, and preoperative distant metastasis were 3 independent risk factors for level IIb lymph node metastasis. This model was built and tested in a validation group, and the area under the curve was 0.840 (P < .001). The cutoff of the IIb score was 12, which was tested in the validation group; the sensitivity was 82.1% and the specificity was 95.6%. CONCLUSION Level IIb dissection should be performed in select patients with IIb scores ≥12.
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Affiliation(s)
- Zheng Liu
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, China
| | - Yang Liu
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, China
| | - Yuxia Fan
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, China
| | - Xiaoming Wang
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, China
| | - Xiubo Lu
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, China.
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Won HR, Chang JW, Kang YE, Kang JY, Koo BS. Optimal extent of lateral neck dissection for well-differentiated thyroid carcinoma with metastatic lateral neck lymph nodes: A systematic review and meta-analysis. Oral Oncol 2018; 87:117-125. [DOI: 10.1016/j.oraloncology.2018.10.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/22/2018] [Accepted: 10/27/2018] [Indexed: 12/22/2022]
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Battoo AJ, Sheikh ZA, Thankappan K, Mir AW, Haji AG. Level V Clearance in Neck Dissection for Papillary Thyroid Carcinoma: A Need for Homogeneous Studies. Int Arch Otorhinolaryngol 2017; 22:449-454. [PMID: 30357101 PMCID: PMC6197978 DOI: 10.1055/s-0037-1608909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 10/23/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction
Papillary thyroid carcinoma has a very high rate of lateral neck node metastases, and there is almost unanimity concerning the fact that some sort of formal neck dissection must be performed to address the clinical neck disease in these cases. Although there is an agreement that levels II to IV need to be cleared in these patients, the clearance of level V is debatable.
Objectives
We herein have tried to analyze various papers that have documented a structured approach to neck dissection in these patients. Moreover, we have also tried to consider this issue through various aspects, like spinal accessory nerve injury and the impact of neck recurrence on survival.
Data Synthesis
The PubMed, Medline, Google Scholar, Surveillance, Epidemiology, and End Results (SEER), and Ovid databases were searched for studies written in English that focused on lateral neck dissection (levels II–IV or II–V) for papillary thyroid carcinoma. Case reports with 10 patients or less were excluded.
Conclusions
The current evidence is equivocal whether to clear level V or not, and the studies published on this issue are very heterogeneous. Level II-IV versus level II-V selective neck dissections in node-positive papillary thyroid carcinoma patients is far from categorical, with pros and cons for both approaches. Hence, we feel that there is a need for more robust homogeneous data in order to provide an answer to this question.
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Affiliation(s)
- Azhar Jan Battoo
- Department of Surgical Oncology (Head and Neck Services), Sher i Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Zahoor Ahmad Sheikh
- Department of Surgical Oncology, Sher i Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Krishnakumar Thankappan
- Department of Head and Neck Surgical Oncology, Amrita Institute of Medical Sciences, Cochin, Kerala, India
| | - Abdul Wahid Mir
- Department of Surgical Oncology, Sher i Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Altaf Gowhar Haji
- Department of Head Surgical Oncology, Sher i Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Lombardi D, Paderno A, Giordano D, Barbieri D, Taboni S, Piazza C, Cappelli C, Bertagna F, Barbieri V, Piana S, Bellafiore S, Spriano G, Mercante G, Nicolai P. Therapeutic lateral neck dissection in well-differentiated thyroid cancer: Analysis on factors predicting distribution of positive nodes and prognosis. Head Neck 2017; 40:242-250. [PMID: 28963802 DOI: 10.1002/hed.24936] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 07/10/2017] [Accepted: 07/27/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Neck dissection is considered the treatment of choice in patients with lateral neck metastases from well-differentiated thyroid cancer. METHODS A multicenter, retrospective review of patients who underwent therapeutic lateral neck dissection for well-differentiated thyroid carcinoma was carried out. RESULTS The study included a total of 405 lateral neck dissections performed in 352 patients; 197 women (56%) and 155 men (44%). When considering ipsilateral neck metastases, levels IIa, IIb, III, IV, Va, Vb, and V (not otherwise specified) were involved in 42%, 6%, 73%, 67%, 11%, 31%, and 35% of cases, respectively. Five-year and 10-year overall survival (OS) were 93% and 81%, respectively. Age >55 years, pathologic T (pT)4 category, tumor diameter >4 cm, aggressive variants of well-differentiated thyroid carcinoma, endovascular invasion, and number of positive nodes >5 turned out to be the most important prognostic factors. CONCLUSION Neck dissection is a valid treatment option in the presence of neck metastasis from well-differentiated thyroid carcinoma. Levels IIa, III, IV, and Vb should always be removed.
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Affiliation(s)
- Davide Lombardi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Alberto Paderno
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Davide Giordano
- Otolaryngology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Diego Barbieri
- Department of Otorhinolaryngology - Head and Neck Surgery, University "San Raffaele", Milan, Italy
| | - Stefano Taboni
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Carlo Cappelli
- Endocrine and Metabolic Unit, University of Brescia, Brescia, Italy
| | | | - Verter Barbieri
- Otolaryngology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Simonetta Piana
- Pathology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | | | - Giuseppe Spriano
- Department of Otorhinolaryngology - Head and Neck Surgery, Istituto Nazionale dei Tumori "Regina Elena", Rome, Italy
| | - Giuseppe Mercante
- Department of Otorhinolaryngology - Head and Neck Surgery, Istituto Nazionale dei Tumori "Regina Elena", Rome, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
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Eweida AM, Sakr MF, Hamza Y, Khalil MR, Gabr E, Koraitim T, Al-Wagih HF, Abo-Elwafa W, Ezzat Abdel-Aziz T, Diab AA, El-Sabaa B, Nabawi AS. Level I lymph node involvement in patients with N1b papillary thyroid carcinoma: a prospective study. Eur Arch Otorhinolaryngol 2017; 274:1951-1958. [PMID: 27999997 DOI: 10.1007/s00405-016-4423-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 12/07/2016] [Indexed: 02/08/2023]
Abstract
Most of the studies on the incidence, pattern, and predictive factors of lymph node (LN) metastasis with papillary thyroid carcinoma (PTC) have been performed retrospectively and no common consensus has been reached regarding the predictors for the involvement of level I LNs. This study was conducted prospectively to determine the incidence and the possible predictors of level I involvement in N1b PTC patients. The study included 30 consecutive patients with N1b stage of PTC. All the patients underwent neck dissection (ND) including level I. The relation between involvement of level I LNs and various clinicopathological variables was studied. Unilateral neck dissection was performed in 24 patients and bilateral neck dissection in six patients leading to 36 NDs. Level I was excised in all patients, with five specimens (14%) positive for metastasis. Levels II, III, IV, V, VI, and VII were positive in 52.8, 58.3, 58.3, 33.3, 63, and 22.2%, respectively. Level I involvement was significantly related to the number of lymph node levels affected (p = 0.003) and macroscopic extranodal invasion (p = 0.04). It was not related to the involvement of other individual levels, gender, age, size of the largest thyroid nodule, size of the largest LN involved, or histo-pathological variant of the tumor. This study suggests that including level I in therapeutic neck dissection for N1b PTC patients might be recommended in selected cases of multiple level involvement and macroscopic extranodal invasion requiring sacrifice of internal jugular vein, spinal accessory nerve, or sternomastoid muscle.
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Affiliation(s)
- Ahmad M Eweida
- Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
- Department of Plastic and Reconstructive Surgery, University of Heidelberg, Heidelberg, Germany.
| | - Mahmoud F Sakr
- Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Yasser Hamza
- Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Mohamed R Khalil
- Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Essam Gabr
- Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Tarek Koraitim
- Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Hatem F Al-Wagih
- Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Waleed Abo-Elwafa
- Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Tarek Ezzat Abdel-Aziz
- Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
- Department of Endocrine Surgery, University College London, London, UK
| | - Ahmed A Diab
- Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Basma El-Sabaa
- Department of Pathology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Aman S Nabawi
- Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
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Vayisoglu Y, Ozcan C. Involvement of level IIb lymph node metastasis and dissection in thyroid cancer. Gland Surg 2014; 2:180-5. [PMID: 25083481 DOI: 10.3978/j.issn.2227-684x.2013.10.04] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 10/17/2013] [Indexed: 11/14/2022]
Abstract
Thyroid neoplasms are the most frequent neoplasm in the head and neck region. Most thyroid carcinomas are well-differentiated tumors of follicular cell origin. Thyroid papillary carcinoma (TPC) is the most common thyroid malignancy. It constitutes 60% to 90% of all the thyroid carcinomas and cervical lymph node metastases are commonly seen in these patients. Although cervical lymph node metastases are common in this cancer, the management and the prognostic role of lymph nodes in TPC remains controversial. In this paper we reviewed the currently available literature regarding the extent of lateral neck dissection in papillary thyroid carcinoma patients with lateral neck metastasis.
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Affiliation(s)
- Yusuf Vayisoglu
- Department of Otorhinolaryngology, Mersin University, Mersin, Turkey
| | - Cengiz Ozcan
- Department of Otorhinolaryngology, Mersin University, Mersin, Turkey
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12
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Park JY, Koo BS. Individualized optimal surgical extent of the lateral neck in papillary thyroid cancer with lateral cervical metastasis. Eur Arch Otorhinolaryngol 2013; 271:1355-60. [DOI: 10.1007/s00405-013-2630-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 07/04/2013] [Indexed: 12/16/2022]
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13
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Eskander A, Merdad M, Freeman JL, Witterick IJ. Pattern of spread to the lateral neck in metastatic well-differentiated thyroid cancer: a systematic review and meta-analysis. Thyroid 2013; 23:583-92. [PMID: 23148663 DOI: 10.1089/thy.2012.0493] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND There remains controversy surrounding the extent of lateral neck dissection required in patients with papillary thyroid cancer (PTC) and suspicious or confirmed metastatic lateral neck lymphadenopathy. The evidence for this clinical dilemma has never been reviewed systematically nor has there been an attempt to meta-analyze the data by lymph node levels to better characterize the pattern of spread. METHODS This meta-analysis used MEDLINE and EMBASE including all cohort studies reporting the pattern of lateral neck disease in patients who underwent a neck dissection for clinically, radiographically, or cytologically suspicious or confirmed metastatic lymphadenopathy for PTC. Our main outcome was the number of patients with positive involvement at a given level as a percentage of the cohort of patients with positive lateral neck disease, each level being measured separately. RESULTS Eighteen studies with a total of 1145 patients and 1298 neck dissections were included in our meta-analysis. Levels IIa and IIb had disease in 53.1% [95% confidence interval (CI) 46.6-59.5%] and 15.5% [CI 8.2-27.2%], respectively. Studies that did not distinguish between level IIa and IIb or in which both were collapsed into one category showed a total level II involvement of 53.4% [CI 49.7-57.1%]. Level III and level IV were involved in 70.5% [CI 67.0-73.9%] and 66.3% [CI 61.4-70.9%] of specimens. Studies that did not distinguish between level Va and Vb or in which both were collapsed into one category showed a total level V involvement of 25.3% [CI 20.0-31.5%]. Levels Va and Vb had positivity in 7.9% [CI 2.8-20.0%] and 21.5% [CI 7.7-47.6%], respectively, but had only three studies that could be meta-analyzed. CONCLUSIONS This systematic review of the literature and meta-analysis of the pattern of spread indicates significant rates of lymph node metastasis to all lateral neck levels in patients with PTC with regional involvement. This evidence leads us to recommend a comprehensive selective neck dissection of levels IIa, IIb, III, IV, and Vb in patients with lateral neck disease from PTC. The evidence for level Va is lacking, as most studies did not distinguish between levels Va and Vb, and the border between the two levels was inconsistent. Future studies will need to address these sublevels separately.
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Affiliation(s)
- Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada.
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Kumar S, Burgess C, Moorthy R. The extent of lateral lymph node dissection in differentiated thyroid cancer in the N+ neck. Eur Arch Otorhinolaryngol 2013; 270:2947-52. [PMID: 23519682 DOI: 10.1007/s00405-013-2434-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 03/05/2013] [Indexed: 10/27/2022]
Abstract
The management of the lateral neck in metastatic differentiated thyroid cancer (DTC) varies widely. Most groups advocate dissection of nodal levels II-IV but many perform a more extensive dissection. We aimed to asses whether there was any evidence for a modified radical neck dissection over a selective neck dissection by looking at the extent to which DTC metastases to levels I and V. We performed a review of the current literature including adult and paediatric patients who underwent a lateral neck dissection for metastatic DTC. The primary endpoint was histological confirmation of metastases in nodal levels I and V. 650 abstracts were identified and reviewed. 23 papers were included in the study. The incidence of level V metastases during routine level V dissection in patients with DTC is 20 % and the incidence of level I metastases during routine level I dissection in patients with DTC is 8 %. Histologically proven metastases were found in 22.5 % of level V neck dissection of which 2.5 % were pre-operatively suspected of metastases. 20 % had histologically proven metastases to level I of which 12 % were pre-operatively suspected of metastases. Our study has shown a 20 % incidence of level V metastases in the N+ neck suggesting that level V should be part of a planned neck dissection. Evidence is lacking for routine dissection of level I. A future prospective study is required to asses the question of risk factors for lateral nodal metastases, recurrence and survival.
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Affiliation(s)
- S Kumar
- Royal Berkshire Hospital, Reading, UK,
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Merdad M, Eskander A, Kroeker T, Freeman JL. Metastatic papillary thyroid cancer with lateral neck disease: Pattern of spread by level. Head Neck 2012; 35:1439-42. [DOI: 10.1002/hed.23149] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2012] [Indexed: 11/11/2022] Open
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Lee SK, Kim SH, Hur SM, Choe JH, Kim JH, Kim JS. The efficacy of lateral neck sentinel lymph node biopsy in papillary thyroid carcinoma. World J Surg 2012; 35:2675-82. [PMID: 21993615 DOI: 10.1007/s00268-011-1254-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although occult lymph node metastasis to the lateral neck compartment is common in papillary thyroid carcinoma, the incidence and patterns of lateral neck node metastasis in papillary carcinoma are not known. We hypothesized that sentinel lymph node biopsy (SLNB) with radioisotope in the detection of occult lateral neck node metastasis would be useful in characterizing metastasis in papillary carcinoma. METHODS Ninety-four patients with papillary thyroid carcinoma were included from June 2009 to March 2010 for lateral neck SLNB. Preoperative lymphoscintigraphy was obtained after intratumoral injection of a (99m)Tc-tin colloid under ultrasound guidance. Total thyroidectomy or lobectomy preceded SLN detection to avoid radioactivity interference with the primary tumor, after which SLNB was performed in the lateral neck nodes. In the cases where metastasis was detected in SLNs upon frozen biopsy, an immediate modified radical neck node dissection was performed. RESULTS A total of 174 SLNs were identified in 60 patients (63.8%). The identification rate of the SLNs with isotope increased with time. Sentinel lymph node metastasis was found in 19 patients (31.7%). This clinically occult metastasis was only related to the total number of metastatic LNs in the central compartment. Patient age, gender, tumor size, location, extent of tumor invasion, multiplicity, and presence of thyroiditis were not related to metastasis in the lateral compartment. Detection of lateral neck SLNs upon biopsy with radioisotope was also feasible in level II and contralateral neck. CONCLUSIONS Sentinel lymph node biopsy is a useful method for evaluating the occult lateral neck lymph node status in patients with papillary thyroid carcinoma, especially in the cases of central neck node metastasis.
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Affiliation(s)
- Se Kyung Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea
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