Experience and analysis of Delphian lymph node metastasis in patients with papillary thyroid carcinoma

Utility of intraoperative Delphian lymph node sampling in pediatric thyroid surgery

OBJECTIVES

The Delphian lymph node (DLN) is the first lymph node receiving drainage from the thyroid. We aim to determine whether routine DLN sampling with frozen section analysis during pediatric thyroidectomy can alter intraoperative surgical decision making. Additionally, we aim to measure whether DLNs can predict a requirement for central neck dissection (CND) in the clinically node negative (CNN) pediatric population.

METHODS

Retrospective chart review for pediatric patients who underwent thyroidectomy between 2014 and 2022. Patients were included if they had prior FNA with a result of: benign nodule, atypia or follicular neoplasm of undetermined significance (AUS/FNUS), follicular neoplasm (FN), or papillary thyroid carcinoma (PTC). All patients had intraoperative DLN analysis via frozen section histopathology.

RESULTS

27 patients were included, 9 males (33 %) and 18 females (67 %). On final pathology 19 patients (70.4 %) had PTC. The DLN was negative for carcinoma in all (n = 8, 100 %) patients with benign pathology. In 10 patients (100 %) with positive DLN on frozen section, postoperative pathology demonstrated central neck metastasis. Nine (90 %) of these patients were CNN and had alterations in the surgical plan based on the DLN. The tenth patient's surgical plan did not change given preoperative clinical disease. Three patients with negative DLNs had central neck metastasis.

CONCLUSION

The DLN serves a role in guiding treatment for the pediatric population. Positive DLN altered surgical plans in 60 % of CNN PTC patients, allowing for CND to be performed and reducing need for additional surgical resection. The positive predictive value for DLN status was 100 % in this study, and the negative predictive value was 62.5 %. However, negative DLNs do not rule out central neck disease.

[Analysis of Delphain lymph node detection rate, metastasis rate and risk factors for metastasis in papillary thyroid adenocarcinoma patients]

Objective:To investigate the detection rate and metastasis rate of delphain lymph node （DLN）in thyroid papillary adenocarcinoma（PTC） and to analyze the risk factors for DLN metastasis. Methods:The clinicopathological data of 200 PTC patients admitted to the from January 2018 to June 2020 were retrospectively analyzed, and the detection of DLN was clearly recorded in the pathological reports of all patients. The number of DLN detected, the number of metastasis, the detection rate and the metastasis rate were counted. The clinicopathological factors that might affect DLN metastasis were analyzed by univariate analysis and multivariate Logistic regression analysis, including gender, age, tumor size and tumor location. Results:DLN was detected in 121 of 200 PTC patients, with a detection rate of 60.50% （121/200）. DLN metastasis was found in 46 of the 121 patients with a metastasis rate of 38.02% （46/121）.Univariate analysis showed that tumor diameter, multiple foci, capsular invasion, extradandular invasion, lymphatic vascular invasion, lymph node metastasis in central region （excluding DLN）, and lateral cervical lymph node metastasis were the risk factors for DLN metastasis of PTC （P<0.05）. Gender, age, tumor location, bilateral tumors, Hashimoto's thyroiditis and BRAFV600E mutation were not significantly correlated with DLN metastasis of PTC（P>0.05）. The 7 variables with statistically significant differences in univariate analysis were incorporated into Logistic regression model for multivariate analysis, and the results showed that, Tumor diameter ≥1.0 cm, capsule invasion, lymphatic vascular invasion, lymph node metastasis in central region （excluding DLN）, and lateral cervical lymph node metastasis were independent risk factors for DLN metastasis of PTC （OR= 3.386-9.186, P<0.05）. The sensitivity and specificity of DLN metastasis in predicting central lymph node （excluding DLN） metastasis in PTC patients were 36.79% and 92.55%, respectively, while the sensitivity and specificity of DLN metastasis in predicting lateral cervical lymph node metastasis were 41.03% and 81.37%, respectively.The incidence of central lymph node metastasis （excluding DLN） in DLN-positive patients were was 4.94 times higher than that in DLN-negative patients, and the incidence of lateral neck lymph node metastasis in DLN-positive patients were 2.20 times higher than that in DLN-negative patients. Conclusion:The detection rate and metastasis rate of DLN in PTC patients were higher, DLN metastasis predicts more extensive lymph node metastasis, and DLN metastasis was related to multiple factors,among which tumor diameter ≥ 1.0 cm, capsule invasion, lymphatic vascular infiltration, lymph node metastasis in the central region （excluding DLN）, and lateral cervical lymph node metastasis were independent risk factors for DLN metastasis of PTC. Therefore, PTC patients with the above characteristics should actively explore DLN and formulate appropriate surgical strategies.

Prelaryngeal and/or pretracheal lymph node metastasis could help to identify papillary thyroid carcinoma with intermediate risk from unilateral lobe cT1-2N0 papillary thyroid carcinoma

Objective

The study aims to explore the possibility of prelaryngeal and/or pretracheal lymph node metastasis in identifying papillary thyroid carcinoma with more than 5 metastatic central lymph nodes from unilateral lobe cT1-2N0 papillary thyroid carcinoma.

Methods

A retrospective analysis was conducted on patients who underwent the initial thyroid surgery for unilateral lobe cT1-2N0 PTC in a single tertiary center between July 2018 to December 2022. Multivariable binary logistic regression analysis was used to identify risk factors for unilateral lobe cT1-2N0 papillary thyroid carcinoma with more than 5 metastatic central lymph nodes.

Results

A total of 737 patients were included in the study and 399 patients were confirmed to suffer from occult central lymph node metastasis. The larger size of the largest diameter of tumor (> 1cm; OR = 3.3, 95%CI 1.6 - 6.83; p = 0.001), pretracheal lymph node metastasis (OR = 5.91, 95%CI 2.73 - 12.77; p < 0.001), prelaryngeal lymph node metastasis (OR = 3.74, 95%CI 1.73 - 8.1; p = 0.001), ipsilateral paratracheal lymph node metastasis (OR = 12.22, 95%CI 3.43 - 43.48; p < 0.001), and contralateral paratracheal lymph node metastasis (OR = 7.68, 95%CI 3.86 - 15.3; p < 0.001) were confirmed to be risk factors for unilateral lobe cT1-2N0 PTC with more than 5 metastatic central lymph nodes. When more than two metastatic prelaryngeal and/or pretracheal lymph nodes occurred, the incidence of more than 5 metastatic central lymph nodes was 71.2%.

Conclusion

Prelaryngeal and/or pretracheal lymph node metastasis could help to identify papillary thyroid carcinoma with more than 5 metastatic central lymph nodes from unilateral lobe cT1-2N0 papillary thyroid carcinoma. When more than two metastatic pretracheal and/or prelaryngeal lymph nodes occurred, total thyroidectomy and ipsilateral central lymph node dissection should be performed and contralateral paratracheal lymph node dissection might be also necessary.

Relationship between pretracheal and/or prelaryngeal lymph node metastasis and paratracheal and lateral lymph node metastasis of papillary thyroid carcinoma: A meta-analysis

Objective

We conducted a meta-analysis to study the relationship between pretracheal and/or prelaryngeal lymph node metastasis and paratracheal and lateral lymph node metastasis in papillary thyroid carcinoma.

Method

A systematic literature search was conducted using PubMed, Embase, and the Cochrane Library electronic databases for studies published up to February 2022. The reference lists of retrieved articles were also reviewed. Two authors independently assessed the methodological quality and extracted the data. A random-effects model was used to calculate the overall pooled relative risk. Publication bias in these studies was evaluated using Egger’s test and Begg’s test.

Results

Twenty-five independent studies involving 10,525 patients were included in the meta-analysis. The pooled relative risk for ipsilateral and contralateral paratracheal lymph node metastasis was 3.01 (95% confidence interval [CI]: 1.66, 5.45) and 5.68 (95% CI: 2.50, 12.88), respectively, in patients with pretracheal lymph node metastasis. Among patients with prelaryngeal lymph node metastasis, the pooled relative risk for ipsilateral paratracheal and/or pretracheal contralateral paratracheal, and lateral lymph node metastasis was 2.02 (95% CI: 1.90, 2.14), 2.22 (95% CI: 1.34, 3.67), and 3.85 (95% CI: 2.89, 5.14), respectively.

Conclusion

Pretracheal lymph node metastasis and prelaryngeal lymph node metastasis were significantly associated with an increased likelihood of both ipsilateral lymph node metastasis and contralateral paratracheal lymph node metastasis in papillary thyroid carcinoma. Prelaryngeal lymph node metastasis was positively correlated with the incidence of lateral lymph node metastasis.

The incidence and features of Delphian lymph node involvement in patients with papillary thyroid carcinoma

Introduction

In papillary thyroid cancer patients, the extent of dissection is still a matter of debate. Evaluating Delphian lymph nodes (DLNs) during the surgery has been speculated as a valuable tool to determine the extent of dissection. Herein, we aimed to evaluate the incidence and features of DLNs involvement in patients with papillary thyroid carcinoma.

Method

We conducted this cross-sectional study among surgical cases of papillary thyroid cancer. Patients were divided based on their DLNs involvement status. Their age, gender, location of the mass, lymphatic involvement, tumor size, tumor characteristics, pathology report, and operation note features were compared between the two groups. Definitive pathology slides of the patients were evaluated regarding DLN features.

Results

Of the 61 patients (mean age: 38.2 ± 12.0), 45 (73.8%) were females. In 13 (21.3%) patients, DLNs involvement was reported. A statistically significant relationship was noted between DLNs involvement and other lymph nodes' involvement on the same side of the mass (P < 0.001), the opposite side (P = 0.041), and also central lymph nodes (P < 0.001). Vascular invasion was also significantly higher among patients with DLNs involvement (P = 0.012).

Conclusion

Since DLNs involvement is significantly associated with extensive nodal involvement, intraoperative evaluation of DLNs is recommended to establish the extent to which dissection should be performed.

Analysis of the Clinical Value of Delphian Lymph Node Metastasis in Papillary Thyroid Carcinoma

Purpose

Delphian lymph node (DLN) is often involved in metastasis of malignant head and neck tumors. This study evaluates the predictive utility of the DLN and the clinicopathological factors related to DLN metastasis in individuals suffering from papillary thyroid carcinoma (PTC). Patients and Methods. A retrospective analysis was made on 969 PTC patients enrolled from 2017 to 2021. Among these patients, 522 PTC patients are DLN positive and 447 are negative. Comparisons of clinicopathological characteristics between the DLN-positive and DLN-negative patients were made.

Results

The DLN was detected in 53.9% (522/969) cases, and DLN metastasis occurred in 20.3% (106/522) cases. The independent predictors of DLN metastasis (DLNM) include tumor size >1 cm, tumor located in the upper third thyroid or isthmus, central lymph node metastasis (CLNM), and lateral lymph node metastasis (LLNM). DLN-positive individuals exhibited a higher incidence and the number of CLNM, contralateral CLNM (CCLNM), and LLNM as compared to DLN-negative patients. Whether it is cN0 or cN+, the CLNM incidence was increased among DLN-positive patients as compared to that of DLN-negative patients.

Conclusions

Positive DLN indicated an increased rate and number of metastases in the cervical lymph nodes. Intraoperative rapid freezing is recommended to assess the status of the DLN, and careful assessment of cervical lymph nodes is warranted when the DLN is involved to implement an appropriate surgical approach.

CDK9 is up-regulated and associated with prognosis in patients with papillary thyroid carcinoma

ABSTRACT

Papillary thyroid carcinoma (PTC) is the most common type of thyroid malignancy but shows excellent prognosis. We investigated the clinical significance of cyclin-dependent kinase 9 (CDK9) in patients with PTC.This prospective observational study included 192 patients with PTC, who visited our hospital between August 2018 and February 2020. We obtained 93 tissue samples from patients with benign thyroid disease during the same period as controls. Immunohistochemical evaluation and reverse transcription-quantitative polymerase chain reaction assay were performed to evaluate CDK9 expression. Patients' demographic and clinical characteristics were analyzed.Delphian lymph node (DLN) metastasis in patients with PTC was associated with clinicopathological characteristics. CDK9 expression was up-regulated in patients with PTC, and those with DLN metastasis showed higher CDK9 expression. We also observed that tumor size, capsule invasion, tumor-node-metastasis classification (TNM) stage, and multifocality were the risk factors for DLN metastasis in patients with PTC. Additionally, CDK9 expression was strongly associated with tumor size, capsule invasion, TNM stage, and multifocality and weakly associated with the number of metastatic DLN.CDK9 is up-regulated in patients with PTC and associated with prognosis in these patients.

Nomograms Combining Ultrasonic Features With Clinical and Pathological Features for Estimation of Delphian Lymph Node Metastasis Risk in Papillary Thyroid Carcinoma

Background

This work explores the clinical significance of Delphian lymph nodes (DLN) in thyroid papillary carcinoma (PTC). At the same time, a nomogram is constructed based on clinical, pathological, and ultrasonic (US) features to evaluate the possibility of DLN metastasis (DLNM) in PTC patients. This is the first study to predict DLNM using US characteristics.

Methods

A total of 485 patients, surgically diagnosed with PTC between February 2017 and June 2021, all of whom underwent thyroidectomy, were included in the study. Using the clinical, pathological, and US information of patients, the related factors of DLNM were retrospectively analyzed. The risk factors associated with DLNM were identified through univariate and multivariate analyses. According to clinical + pathology, clinical + US, and clinical + US + pathology, the predictive nomogram for DLNM was established and validated.

Results

Of the 485 patients with DLN, 98 (20.2%) exhibited DLNM. The DLNM positive group had higher positive rates of central lymph node metastasis (CLNM), lateral lymph node metastasis (LLNM), and T3b–T4b thyroid tumors than the negative rates. The number of CLNM and LLNM lymph nodes in the DLNM+ group was higher as compared to that in the DLNM- group. Multivariate analysis demonstrated that the common independent risk factors of the three prediction models were male, bilaterality, and located in the isthmus. Age ≥45 years, located in the lower pole, and nodural goiter were protective factors. In addition, the independent risk factors were classified as follows: (I) P-extrathyroidal extension (ETE) and CLNM based on clinical + pathological characteristics; (II) US-ETE and US-CLNM based on clinical + US characteristics; and (III) US-ETE and CLNM based on clinical +US + pathological features. Better diagnostic efficacy was reported with clinical + pathology + US diagnostic model than that of clinical + pathology diagnostic model (AUC 0.872 vs. 0.821, p = 0.039). However, there was no significant difference between clinical + pathology + US diagnostic model and clinical + US diagnostic model (AUC 0.872 vs. 0.821, p = 0.724).

Conclusions

This study found that DLNM may be a sign that PTC is more invasive and has extensive lymph node metastasis. By exploring the clinical, pathology, and US characteristics of PTC progression to DLNM, three prediction nomograms, established according to different combinations of features, can be used in different situations to evaluate the transfer risk of DLN.

Clinicopathological characteristics of papillary thyroid cancer located in the isthmus with Delphian lymph node metastasis

Papillary thyroid carcinomas (PTC) arising from the isthmus have aggressive clinical and pathological features, especially regarding the Delphian lymph node (DLN), which are associated with poor overall and disease-specific survival of patients with head and neck cancer. In the present study, we evaluated clinicopathological characteristics in 195 DLN-positive isthmus PTCs (14.9%) and their lymph node metastatic pattern in 1305 isthmus PTC patients in our hospital between January 2016 and July 2019. Furthermore, a multivariate analysis was conducted to investigate independent risk factors for isthmus PTC with a positive DLN. The results showed that a positive DLN was significantly related to tumour size, extrathyroid extension, median number of DLN, and metastasis to the central, bilateral central, lateral, and pretracheal lymph nodes. Meanwhile, patients with DLN-positive PTC had a significantly increased incidence of suspected preoperative lymph node status than patients with DLN-negative PTC. Multivariate logistic regression of DLN metastasis in PTC located in the isthmus showed that tumour size, extrathyroid extension, and metastasis to the central, bilateral central, lateral, and pretracheal lymph nodes, were independent risk factors.

Multi-Order Brain Functional Connectivity Network-Based Machine Learning Method for Recognition of Delayed Neurocognitive Recovery in Older Adults Undergoing Non-cardiac Surgery

Objectives: Delayed neurocognitive recovery (DNR) seriously affects the post-operative recovery of elderly surgical patients, but there is still a lack of effective methods to recognize high-risk patients with DNR. This study proposed a machine learning method based on a multi-order brain functional connectivity (FC) network to recognize DNR.

Method: Seventy-four patients who completed assessments were included in this study, in which 16/74 (21.6%) had DNR following surgery. Based on resting-state functional magnetic resonance imaging (rs-fMRI), we first constructed low-order FC networks of 90 brain regions by calculating the correlation of brain region signal changing in the time dimension. Then, we established high-order FC networks by calculating correlations among each pair of brain regions. Afterward, we built sparse representation-based machine learning model to recognize DNR on the extracted multi-order FC network features. Finally, an independent testing was conducted to validate the established recognition model.

Results: Three hundred ninety features of FC networks were finally extracted to identify DNR. After performing the independent-sample T test between these features and the categories, 15 features showed statistical differences (P < 0.05) and 3 features had significant statistical differences (P < 0.01). By comparing DNR and non-DNR patients’ brain region connection matrices, it is found that there are more connections among brain regions in DNR patients than in non-DNR patients. For the machine learning recognition model based on multi-feature combination, the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity of the classifier reached 95.61, 92.00, 66.67, and 100.00%, respectively.

Conclusion: This study not only reveals the significance of preoperative rs-fMRI in recognizing post-operative DNR in elderly patients but also establishes a promising machine learning method to recognize DNR.

Diagnostic Model Incorporating Clinicopathological Characteristics of Delphian Lymph Node Metastasis Risk Profiles in Papillary Thyroid Cancer

The Delphian lymph node (DLN), also known as the prelaryngeal node, is one component of the central lymph node. The DLN has been well studied in laryngeal cancer, although its significance in papillary thyroid cancer (PTC) remains unclear. We retrospectively analyzed 936 patients with PTC who underwent thyroidectomy by a single surgeon in Tianjin Cancer Hospital from 2017 to 2019. Moreover, 250 PTC patients who underwent thyroidectomy by another surgeon in Tianjin Cancer Hospital from January 2019 to April 2019 were used as a validation cohort. Among the 936 patients with PTC, 581 patients (62.1%) had DLNs, of which 177 samples with metastasis (177/581, 30.5%) were verified. DLN metastasis was significantly correlated with sex, age, tumor size, bilateral cancer, multifocality, extrathyroidal extension, lymphovascular invasion and central and lateral neck lymph node metastasis. Multivariate analysis revealed that independent risk factors for DLN metastasis included age, gender, tumor size, extrathyroid extension, lymphovascular invasion and central lymph node metastasis, which determined the nomogram. In particular, tumor size was proven to be one of the most predominant single predictors. The diagnostic model had an area under the curve (AUC) of 0.829 (95% confidence interval, 0.804-0.854). The internal and external validations of the nomogram were 0.819 and 0.745, respectively. Our results demonstrate that DLN metastasis appears to be a critical parameter for predicting metastatic disease of the central compartments. Furthermore, this study provides a precise criterion for assessing DLN metastasis and has great clinical significance for treating PTC.

Delphian lymph node metastasis is a novel indicator of tumor aggressiveness and poor prognosis in papillary thyroid cancer

BACKGROUND AND OBJECTIVES

Although the significance of Delphian lymph nodes (DLNs) in patients with papillary thyroid carcinoma (PTC) has been reported, all studies have been based on a small sample size and lack a direct statement concerning prognosis.

METHODS

A total of 904 consecutive patients were enrolled in the current study, and all patients were divided into two groups (DLN-positive and DLN-negative) according to the presence of DLN metastasis.

RESULTS

DLN was detected in 687 patients (76.0%), and 123 (17.9%) had DLN metastasis. Compared to those in the DLN-negative group, the proportion of other central lymph node (CLN) metastases, mean number of metastatic CLNs, and mean metastatic CLN ratio were higher in the DLN-positive group (86.2 vs. 50.2%, 6.70 ± 5.19 vs. 1.60 ± 2.37, and 0.54 ± 0.25 vs. 0.18 ± 0.26, respectively; p < .001). The same phenomena were observed in the metastatic lateral lymph nodes (LLNs) between the DLN-positive and DLN-negative groups (52.0 vs. 15.4%, 7.28 ± 6.08 vs. 3.38 ± 3.73, and 0.23 ± 0.15 vs. 0.13 ± 0.12, respectively; p < .001). Patients in the DLN-positive group had shorter LLN metastasis-free survival and distant metastasis-free survival than patients in the DLN-negative group (93.5% vs. 98.6% and 95.9% vs. 98.8%, respectively, p < .05).

CONCLUSIONS

DLN metastasis in PTC is associated with tumor aggressiveness and a poor prognosis.

Predictive value of the Delphian lymph node in cervical lymph node metastasis of papillary thyroid carcinoma

INTRODUCTION

Delphian lymph node metastasis (DLNM) has proven to be a risk factor for a poor prognosis in head and neck malignancies. This study aimed to reveal the clinical features and evaluate the predictive value of the Delphian lymph node (DLN) in papillary thyroid carcinoma (PTC) to guide the extent of surgery.

METHODS

Tianjin Medical University Cancer Institute and Hospital pathology database was reviewed from 2017 to 2020, and 516 PTC patients with DLN detection were enrolled. Retrospective analysis was performed, while multivariate analysis was performed to identify the risk factors for DLNM.

RESULTS

Among the 516 PTC patients with DLN detection, the DLN metastasis rate was 25.39% (131/516). Tumor size >1 cm, location in the upper 1/3, central lymph node metastasis (CLNM), lateral lymph node metastasis (LLNM) and lymphovascular invasion were independent risk factors for DLNM. Patients with DLNM had a higher incidence of ipsilateral CLNM, contralateral CLNM (CCLNM) and LLNM, and larger numbers and size of metastatic CLNs than those without DLNM. The incidence of CLNM among cN0 patients with DLNM was higher than that among those without DLNM. The incidence of CCLNM among unilateral cN + patients with DLNM was similarly higher than that among patients without DLNM.

CONCLUSIONS

DLNM indicates a high likelihood and large number of cervical lymph nodes metastases in PTC patients. Surgeons are strongly recommended to detect DLN status during operation by means of frozen pathology, so as to evaluate the possibility of cervical nodal metastasis and decide the appropriate extent of surgery.

Predictive Value of Delphian Lymph Node Metastasis in the Thyroid Cancer

OBJECTIVE/HYPOTHESIS

To evaluate the diagnostic accuracy of Delphian lymph node (DLN) metastasis for the prediction of central lymph node (CLN) metastasis and lateral lymph node (LLN) metastasis.

METHODS

Two authors independently reviewed the six databases (Cochrane database, Embase, Google Scholar, PubMed, SCOPUS, and Web of Science). Four parameters were extracted from each study: true positive, true negative, false positive, and false negative. The quality of the methodology was evaluated using the Quality Assessment of Diagnostic Accuracy Studies ver. 2 tool.

RESULTS

The diagnostic odds ratio of DLN in CLN metastasis was 8.859 (95% confidence interval [CI], 4.419; 16.578). The area under the summary receiver operating characteristic curve was 0.748. The diagnostic odds ratio of DLN in LLN metastasis was 7.61 (95% CI, 4.48; 12.94). The area under the summary receiver operating characteristic curve was 0.837. DLN metastasis was moderately predictive of CLN metastasis (sensitivity = 32%, specificity = 95%), LLN metastasis (sensitivity = 52%, specificity = 89%), and contralateral CLN metastasis (sensitivity = 46%, specificity = 85%). DLN metastasis had statistically significant correlation with specific clinicopathological characteristics, including younger age (< 45 years old), bilaterality, capsule invasion, extrathyroidal extension, lymphovascular invasion, male sex, multifocality, and tumor size (> 1 cm).

CONCLUSIONS

The higher specificities of DLN pathology may help predict central and lateral compartment involvement in patients with thyroid cancer.

LEVEL OF EVIDENCE

NA Laryngoscope, 131:1990-1996, 2021.

Diagnostic and mechanistic values of microRNA-130a and microRNA-203 in patients with papillary thyroid carcinoma

This research was determined to unearth the diagnostic values and the effects of microRNA (miR)-130a and miR-203 on cell proliferation and apoptosis of papillary thyroid carcinoma (PTC). Expression of miR-130a and miR-203 were evaluated and were subjected to correlation analysis. The diagnostic values of miR-130a and miR-203 and their associations with clinicopathological characteristics of patients with PTC were measured. The expression levels of miR-130a and miR-203 in K1, IHH4, TPC-1, and BCPAP cells together with Nthy-ori 3-1 cells were measured. Cells were transfected with miR-130a mimics, miR-203 mimics, and coordinate of miR-130a mimics and miR-203 mimics. Cell growth, colony formation, and apoptosis were detected by cell counting kit-8 (CCK-8) assay, colony formation assay, and flow cytometry. PTC tissues had decreased miR-130a and miR-203 relative to adjacent normal tissues and normal thyroid tissue (both P < .05). miR-130a was in positive correlation with miR-203 (r = 0.754, P < .01). miR-130a was related with tumor infiltration and tumor stage while miR-203 was implicated in tumor stage and lymph-node metastasis. The area under the curve (AUC), sensitivity, as well as specificity for miR-130 in predicting PTC was 0.839, 74.5%, and 85.0% and those for miR-203 were 0.818, 73.7%, and 84.0%, respectively. PTC cells had lower expression of miR-130a and miR-203 than that in Nthy-ori 3-1 cells. After transfected miR-130a and miR-203 mimics in BCPAP and TPC-1 cells, both cells had increased miR-130a and miR-203, promoted cell apoptosis rate and decreased cell growth rate, and colony formation ability. After coordinately transfected with miR-130a mimics and miR-203 mimics, the cell growth and colony formation ability of PTC cells were restrained, and apoptosis of PTC cells was elevated (all P < .05). This study highlights that miR-130a and miR-203 have satisfactory diagnostic value in PTC and upregulated miR-130a and miR-203 can inhibit PTC cell growth and promote cell apoptosis.

The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults

OBJECTIVE

To develop evidence-based recommendations for safe, effective, and appropriate thyroidectomy.

BACKGROUND

Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the US.

METHODS

The medical literature from 1/1/1985 to 11/9/2018 was reviewed by a panel of 19 experts in thyroid disorders representing multiple disciplines. The authors used the best available evidence to construct surgical management recommendations. Levels of evidence were determined using the American College of Physicians grading system, and management recommendations were discussed to consensus. Members of the American Association of Endocrine Surgeons reviewed and commented on preliminary drafts of the content.

RESULTS

These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Fine Needle Aspiration Biopsy Diagnosis, Molecular Testing, Indications, Extent and Outcomes of Surgery, Preoperative Care, Initial Thyroidectomy, Perioperative Tissue Diagnosis, Nodal Dissection, Concurrent Parathyroidectomy, Hyperthyroid Conditions, Goiter, Adjuncts and Approaches to Thyroidectomy, Laryngology, Familial Thyroid Cancer, Postoperative Care and Complications, Cancer Management, and Reoperation.

CONCLUSIONS

Evidence-based guidelines were created to assist clinicians in the optimal surgical management of thyroid disease.

Clinical Study on Prelaryngeal Lymph Node Metastasis in Papillary Thyroid Carcinoma

Objective

This study aims to investigate the risk factors of prelaryngeal lymph node metastasis in papillary thyroid carcinoma and its clinical application value.

Methods

The clinical pathological features and metastatic risks were statistically analyzed by reviewing 254 patients with papillary thyroid carcinoma, who received their first operation and prelaryngeal lymph node dissection in our department.

Results

The detection of prelaryngeal lymph nodes, tumor size and any paratracheal lymph node metastasis were correlated with the number of paratracheal lymph node metastasis (P<0.05), but these were not correlated with age, gender, multiple foci, tumor size, any paratracheal lymph node metastasis, metastatic location, or foci location (P>0.05).

Conclusion

Paratracheal lymph node metastasis indicates a high possibility of prelaryngeal lymph node metastasis. Paratracheal lymph node dissection combined with prelaryngeal lymph node dissection should be simultaneously considered in operations for thyroid papilla carcinoma.

Clinical implications of Delphian lymph node metastasis in papillary thyroid carcinoma: a single-institution study, systemic review and meta-analysis

BACKGROUND

To evaluate the possible predictive value and clinicopathological characteristics of Delphian lymph node metastasis in papillary thyroid carcinoma.

METHODS

A retrospective analysis of papillary thyroid carcinoma patients with Delphian lymph node metastasis in a single institution and meta-analysis of literature reports were performed.

RESULTS

In own series, Delphian lymph node metastasis was detected in 19 (9.9%) of 192 papillary thyroid carcinoma patients and was significantly associated with tumor size≥1 cm (P = 0.003), multifocality (P = 0.006) and extrathyroid extension (P < 0.001) in the multivariate analysis. Female was a protective factor for Delphian lymph node metastasis (P = 0.001). Delphian lymph node metastasis was highly predictive of further central lymph node metastasis (positive predictive value = 89.5%, negative predictive value = 67.6%) and moderately predictive of lateral lymph node metastasis (positive predictive value = 26.3%, negative predictive value = 95.4%). In this meta-analysis, there was a strong correlation between Delphian lymph node metastasis and aggressive clinicopathologic characteristics with regards to multifocality (P = 0.0008), bilaterality (P = 0.04), extrathyroid extension (P < 0.00001), lymphovascular invasion (P < 0.00001), further central lymph node metastasis (P < 0.00001) and lateral lymph node metastasis (P < 0.00001).

CONCLUSIONS

This single-institution observational study and meta-analysis identified that Delphian lymph node metastasis was significantly associated with unfavorable clinicopathological characteristics and had a strong predictive power for further disease in the central compartment.

TRIAL REGISTRATION

The clinical study was retrospectively registered to UMIN clinical trials registry (the registry number: UMIN000033835 ).

Use of Delphian lymph node metastasis to predict central and lateral involvement in papillary thyroid carcinoma: A systematic review and meta-analysis

OBJECTIVE

Whether Delphian lymph node (DLN) metastasis is a reliable predictor of widespread lymph node metastasis in papillary thyroid carcinoma (PTC) remains controversial. This meta-analysis investigated the value of DLN metastasis for predicting central and lateral involvement in PTC.

DESIGN AND METHODS

A literature search using the PubMed, SCIE and the Chinese National Knowledge Infrastructure (CNKI) databases was conducted. Two reviewers independently extracted data and evaluated the studies for inclusion. Fixed-effects and random-effects models were used to analyse the data based on their heterogeneity. A sensitivity analysis was performed, and publication bias was assessed using Begg's funnel plot and Egger's linear regression test.

RESULTS

Data from 10 studies were analysed. The risk of central lymph node (CLN) metastasis was significantly higher in the DLN-positive group than in the DLN-negative group (OR = 9.05, 95% CI: 5.13-15.99) with moderate heterogeneity (P = 0.022, I²  = 53.5%). The risk of lateral lymph node (LLN) metastasis was significantly higher in the DLN-positive group than in the negative group (OR = 10.88, 95% CI: 7.60-15.58), with low heterogeneity (P = 0.603, I²  = 0.0%). Sensitivity analysis indicated that the results were stable and credible, and no publication bias was found.

CONCLUSIONS

Delphian lymph node metastasis is valuable for predicting central and lateral compartment involvement in patients with PTC. The DLN of PTC patients should be dissected intraoperatively and sent for frozen section consultation. If the result is positive, the CLNs should be thoroughly dissected and the LLNs should be further evaluated.

Patterns and clinical significance of cervical lymph node metastasis in papillary thyroid cancer patients with Delphian lymph node metastasis

Although the roles of Delphian lymph node (DLN) metastasis in papillary thyroid cancer (PTC) have been previously reported, there are still limited data on correlations of clinicopathologic factors with DLN metastasis and unique patterns of cervical node subsite metastasis in PTC patients with DLN metastasis. We retrospectively reviewed medical records of 320 patients with a diagnosis of PTC who underwent primary surgery. Clinicopathologic features and DLN metastasis patterns were analyzed for predicting extensive cervical lymph node metastasis. Both univariate and multivariate Cox regression analyses were used to identify independent factors for cervical lymph node metastasis. DLN metastasis was significantly associated with multifocality, tumor size > 1 cm, extrathyroid extension, BRAF^V600E mutation, central neck node metastasis (CNNM), and lateral neck nodes metastases. Patients with DLN metastasis had more lymph node metastases in the central compartment. CNNM number and tumor size > 1 cm were independent risk factors for DLN metastasis. DLN metastasis was highly predictive of lateral lymph node metastasis with moderate sensitivity and high specificity. DLN metastasis is associated with several poor prognostic factors, including extensive cervical lymph node metastasis, and can serve as a predictor of advanced PTC. The presence of DLN metastasis should prompt surgeons to perform an aggressive surgery approach.

Clinicopathologic characteristics and pattern of central lymph node metastasis in papillary thyroid cancer located in the isthmus

OBJECTIVES/HYPOTHESIS

The aim of this study was to evaluate the clinicopathologic characteristics and pattern of lymph node (LN) metastasis in papillary thyroid cancer (PTC) located in the isthmus.

STUDY DESIGN

Retrospective cohort study.

METHODS

One hundred ninety consecutive patients with PTC who underwent total thyroidectomy and bilateral central neck dissection were analyzed. Preoperative ultrasonography was reviewed to identify PTC located in the isthmus. Clinicopathologic factors including age, sex, tumor size, extrathyroidal extension (ETE), margin, angiolymphatic invasion, and nodal metastasis were evaluated.

RESULTS

Of 190 PTC patients, 14 patients (7.3%) had a tumor located in the isthmus. The PTCs located in the isthmus were more likely to have ETE and central LN involvement. Furthermore, PTCs located in the isthmus had a higher frequency of metastasis to pretracheal and prelaryngeal LNs than those located in the lobes.

CONCLUSION

PTCs located in the isthmus were associated with ETE and more likely to involve the pretracheal and prelaryngeal LNs.

LEVEL OF EVIDENCE

4 Laryngoscope, 126:2419-2421, 2016.

Importance of Delphian Lymph Node Evaluation in Autoimmune Thyroiditis: Fact or Fiction?

Background

Our main objective was to evaluate the association between autoimmune thyroiditis and the Delphian lymph node during different stages of thyroiditis.

Material/Methods

The relationships between the ultrasonography (US) results of thyroiditis and characteristics of the Delphian lymph node in different stages of AT were evaluated. Thyroid hormone and antibody levels were assessed. A total of 126 patients were divided into four groups according to the thyroid US findings: Group 1: control cases; Group 2: indeterminate cases; Group 3: established thyroiditis cases; Group 4: advanced-late stage thyroiditis cases.

Indeterminate cases attended a 1-year follow-up, and the cases with a sonographic finding matching thyroiditis formed Group 2.

Results

The rate of Delphian lymph node presence in Group 4 was significantly higher than in Groups 1 and 2 (p<0.01). In addition, its presence was significantly higher in Group 3 than in Group 1 (p<0.05). Although there was a difference in Delphian lymph node presence between Groups 2 and 3, it was not significant (p=0.052), nor was there a significant difference between Groups 1 and 2 (p>0.05). Both the long and short axis measurements were significantly higher in Groups 2, 3, and 4 compared to those in the control group. However, the same increase was not observed in the long/short axis ratio.

Conclusions

Both the presence and dimensions of the Delphian lymph node were highly correlated with the progress of autoimmune thyroiditis. Evaluating the Delphian lymph nodes might prevent missing a diagnosis of autoimmune thyroiditis.

The significance of Delphian lymph node in papillary thyroid cancer

AIM

To investigate the clinical significance of the DLN metastasis in papillary thyroid cancer (PTC).

METHODS

A total of 231 PTC patients who underwent first surgical treatment in the Department of Hand and Neck Surgery of Zhejiang Cancer Hospital from January 2013 to June 2014 were enrolled. The relationship between Delphian lymph node (DLN) metastasis and patient age, gender, tumor size, tumor number, unilateral or bilateral, capsular invasion, pretracheal and paratracheal node metastasis, and lateral node metastasis was analyzed.

RESULTS

Within 231 cases, 69 showed DLN, but only 19 (8.23%) were found with metastasis. In the univariate analysis, DLN metastasis was significantly associated with tumor size (P = 0.023), capsular invasion (P = 0.001), pretracheal or paratracheal node metastasis (P = 0.003) and lateral node metastasis (P = 0.001), while there were no significant correlation between DLN metastasis and gender (P = 0.976), age (P = 0.976), tumor number (P = 0.234) and unilateral or bilateral (P = 0.724). In the multivariate analysis, capsular invasion was an independent risk factor of DLN metastasis (P < 0.05, odds ratio = 10.15).

CONCLUSION

Capsular invasion is an independent risk factor of DLN metastasis and DLN metastasis could be used as a predictor of lateral node metastasis. The dissection of DLN in PTC patients is recommended and lateral lymph node should be evaluated for patients with DLN positive.

Prediction of ipsilateral and contralateral central lymph node metastasis in unilateral papillary thyroid carcinoma: a retrospective study

BACKGROUND

Prophylactic central lymph node dissection (CLND) in patients with papillary thyroid carcinoma (PTC) remains controversial and predictive factors for central lymph node (CLN) metastasis in unilateral PTC cases are not well defined. The aims of this study were to evaluate the rate of ipsilateral and contralateral CLN metastasis and to determine the clinicopathologic factors predictive for ipsilateral and contralateral CLN metastasis in unilateral PTC cases.

METHODS

We retrospectively reviewed 218 PTC patients with clinically negative-node neck who have received total thyroidectomy with bilateral CLND. Pearson χ(2) test or Fisher exact test and multivariate analysis were used to evaluate relationships between CLN metastasis and demographic factors such as age, sex and the clinicopathologic factors.

RESULTS

Ipsilateral and contralateral CLN metastasis were present in 47.7% (104/218) and 13.3% (29/218), respectively. Multivariate analysis showed that tumor size (>1 cm) (P=0.016; OR, 2.005) and age <45 years old (P=0.031; OR, 1.539) were the predictors of ipsilateral CLN metastasis, and prelaryngeal lymph node (LN) metastasis (P=0.028; OR, 2.970) and ipsilateral CLN metastasis (P<0.001; OR, 15.128) independently predicted contralateral CLN metastasis.

CONCLUSIONS

CLN metastasis was common in PTC patients with clinically node-negative neck and the most common pattern of CLN metastasis was ipsilateral CLN metastasis. Prophylactic ipsilateral CLND may be an optional procedure and should be considered for patients with a tumor size >1 cm. Therapeutic bilateral CLND should be considered in patients with a tumor size >1 cm and especially, if there exists prelaryngeal LN or ipsilateral CLN metastasis on frozen section analysis.

The total number of prelaryngeal and pretracheal lymph node metastases: is it a reliable predictor of contralateral central lymph node metastasis in papillary thyroid carcinoma?

BACKGROUND

Central lymph node (CLN) metastasis in papillary thyroid carcinoma (PTC) is common and being able to predict CLN metastasis helps surgeons determine individualized therapy. However, the relationship between contralateral CLN metastasis and the total number of positive lymph nodes (LNs) in the combined prelaryngeal and pretracheal region remains unclear. This study aimed to investigate whether the total number of positive LNs in the combined prelaryngeal and pretracheal region has clinical significance as a predictor for contralateral CLN metastasis.

METHODS

We prospectively enrolled 153 consecutive patients with unifocal PTC >1.0 cm without ultrasonographic evidence of nodal metastasis who underwent total thyroidectomy and prophylactic bilateral CLN dissection from July 2011-May 2013. Patients were divided into three groups according to the total number of positive LNs in the combined prelaryngeal and pretracheal region.

RESULTS

Rates of metastasis to ipsilateral and contralateral central compartments in PTC >1.0 cm were 84.3% and 24.2%, respectively. Multivariate analysis showed that ≥3 positive LNs in the combined prelaryngeal and pretracheal region were an independent predictive factor of contralateral CLN metastasis (P < 0.001; odds ratio, 8.585). After a mean follow-up of 24.1 mo, none of these patients had a recurrence in the central or lateral compartment.

CONCLUSIONS

Occult metastasis is highly prevalent in the ipsilateral central neck of patients with PTC >1.0 cm, and the total number of prelaryngeal and pretracheal LNs metastases may be a useful indicator to predict contralateral CLN metastasis in patients with unifocal PTC.

Papillary thyroid carcinoma located in the isthmus or upper third is associated with Delphian lymph node metastasis

BACKGROUND

Delphian lymph node (DLN) metastasis is a recognized indicator of further lymph node involvement in papillary thyroid carcinoma (PTC). The aim of this study was to evaluate the clinicopathological significance of and risk factors for DLN metastasis.

METHODS

The medical records of 1,436 patients who underwent primary thyroidectomy for classical PTC with a tumor size of 2 cm or less were reviewed. Of these, 370 patients from whom the DLN was harvested were enrolled. Metastasis in DLN was present in 46 patients and absent in 324 patients. Clinicopathological features were compared according to DLN metastasis.

RESULTS

In univariate analysis, DLN metastasis was associated with suspected lymph node metastasis on preoperative ultrasonography, tumor location in the isthmus or upper third of the thyroid, larger tumor size, extrathyroid extension, lymphovascular invasion, and further lymph node metastasis. Multivariable analysis revealed that DLN metastasis was associated with tumor location in the isthmus or upper third of the thyroid (odds ratio [OR] = 2.420; 95 % confidence interval [CI] 1.193-4.910) and further lymph node metastasis (OR = 4.746; 95 % CI 2.065-10.908).

CONCLUSIONS

DLN metastasis in PTC is associated with tumor location in the isthmus or upper third of the thyroid and unfavorable clinicopathological characteristics. Careful consideration and patient management are warranted when preoperative ultrasonography indicates that the tumor is located in the isthmus or upper third of the thyroid.

Incidence and clinical characteristics of prelaryngeal lymph node metastasis in papillary thyroid cancer

There is little data that determine the clinical characteristics of prelaryngeal lymph nodes (PLN) metastasis in patients with papillary thyroid cancer (PTC). The aims of this prospective study were to evaluate the incidence and the clinical characteristics of metastasis to the PLN for PTC patients who underwent total thyroidectomy and prophylactic central neck dissection. Sixty-seven patients who underwent total thyroidectomy and prophylactic bilateral central lymph node neck dissection for PTC were enrolled. Central neck compartment was further divided into prelaryngeal, ipsilateral/contralateral paratracheal, and pretracheal regions. Clinicopathologic factors including age, sex, tumor size and location, extrathyroidal extension, and central and lateral nodal metastasis were evaluated. Of the 67 patients who underwent PLN dissection, 13 (19.4 %) had evidence of PLN metastasis. Tumor size was significantly larger in patients with PLN involvement (2.28 versus 1.12 cm; p = 0.020). Additionally, primary tumors larger than 1 cm, extrathyroidal extension, and isthmus involvement were more prevalent in PLN-positive patients. Patients with positive PLNs were also more frequently found to have lateral lymph node metastasis (23.1 vs. 1.9 %; p = 0.021), pretracheal lymph node metastasis (76.9 vs. 27.8 %; p = 0.003), and bilateral central lymph node metastasis (38.5 vs. 11.1 %; p = 0.031) than PTC patients without PLN involvement. The incidence of PLN metastasis in PTC patients who underwent prophylactic central lymph node neck dissection was 19.4 %. PLN metastasis was associated with tumor size, extrathyroidal extension, isthmus involvement, and other compartment lymph node metastasis.