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Tri BDM, Chi BDP, Hiep BT, Trung NH, Minh TD, Dung NTN, Bui TD, Tran VQ, Nguyen HT. Relationship of Recurrence Rate with some Characteristics in Patients with Thyroid Carcinoma. Indian J Endocrinol Metab 2023; 27:544-551. [PMID: 38371183 PMCID: PMC10871007 DOI: 10.4103/ijem.ijem_134_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/27/2023] [Accepted: 06/25/2023] [Indexed: 02/20/2024] Open
Abstract
Background Determining the clinical and subclinical characteristics related to the recurrence status in patients with a thyroid carcinoma has great significance for prognosis, prediction of recurrence and monitoring of treatment outcomes. This study aimed to determine the association between recurrence rate and some characteristics in patients with thyroid carcinoma. Patients and Methods The study was conducted by descriptive method with longitudinal follow-up on 102 thyroid carcinoma patients at 103 Military Hospital, Hanoi, Vietnam, from July 2013 to December 2016. Results Univariate analysis showed that there was a relationship between the recurrence characteristics in the studied patients and the characteristics of lymph node metastasis (P = 0.026; OR = 15; 95% CI = 1.4-163.2) and BRAF V600E mutation status (P = 0.01; OR = 3.41; 95% CI = 1.31-8.88). When analysing the multivariable Logistic regression model, there was a positive correlation between the occurrence of BRAF V600E gene mutation (P = 0.032; OR = 17.649; 95% CI = 1.290-241.523) and male sex (P = 0.036; OR = 12.788; 95% CI = 1.185-137.961) and the occurrence of recurrence in study patients. The mean time to relapse was earlier in male patients than in female patients (P = 0.02). The mean time to relapse in patients with the BRAF V600E mutation (31.81 ± 1.14 months) was shorter than the mean time to relapse in the group without the mutation (57.82 ± 2.08 months) (P = 0.01). The group of patients with mutations in the BRAF V600E gene increased the risk of recurrence compared with the group without the mutation (HR = 9.14, P = 0.04). Conclusion There is a positive correlation between recurrence and masculinity, lymph node metastasis and the occurrence of BRAF V600E mutations in thyroid carcinoma patients.
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Affiliation(s)
- Bui D. M. Tri
- Centre for Health Professionals Training, Ho Chi Minh City, Vietnam
| | - Bui D. P. Chi
- Department of Diagnostic Imaging, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Bui T. Hiep
- Department of Pharmacology - Clinical Pharmacy, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Nguyen H. Trung
- Department of Military Hygiene, Vietnam Military Medical University, Hanoi, Vietnam
| | - Tong D. Minh
- Department of Military Hygiene, Vietnam Military Medical University, Hanoi, Vietnam
| | | | - Thanh D. Bui
- Military Medical Hospital 175, Ho Chi Minh City, Vietnam
| | - Viet Q. Tran
- Military Medical Hospital 175, Ho Chi Minh City, Vietnam
| | - Hiep T. Nguyen
- Department of Family Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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Lv T, Ma WL, Tan Z, Jiang LH, Liang JY, Wu JJ, Hou CJ, Ge MH, Wang JF. Level II lateral neck dissection for papillary thyroid carcinoma: A retrospective cohort study. Asian J Surg 2023; 46:4290-4295. [PMID: 37085417 DOI: 10.1016/j.asjsur.2023.04.003] [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: 08/01/2022] [Revised: 01/03/2023] [Accepted: 04/03/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND For N1b papillary thyroid carcinoma (PTC) patients, lateral neck dissection encompassing levels Ⅱ-Ⅴ is generally recommended. However, routine level Ⅱ dissection is controversial given the low incidence of metastasis, and potential complications such as increased shoulder syndrome. METHODS Retrospective analysis of consecutive patients with papillary thyroid carcinoma who underwent lateral neck dissection at a single institution from January 2019 to April 2021 was performed. Clinicopathological features such as age, gender, tumor location, tumor size, TgAb and TPOAb levels, capsular invasion, multifocality and lymph node metastases were examined to evaluate the occurrence of metastatic Level Ⅱ lymph nodes. RESULTS Overall and occult level Ⅱ metastases were observed in 51.83% and 34.84% of cN1b PTC patients. Multivariant analysis showed that primary tumor, location of primary tumor and positive level Ⅴ can serve as independent risk factors of metastasis in level Ⅱ. For cN1b PTC patients not suspected of level Ⅱ lymph nodes preoperatively, independent risk factors for predicting occult level Ⅱ metastases may include the location of primary tumor, positive level Ⅲ and positive level Ⅴ. CONCLUSION A significant number of patients with PTC and lateral neck disease experienced Level Ⅱ metastasis, with the location of primary tumor and multilevel lymph node involvement being the independent risk factors. If the tumor is less than 1 cm and located at lower 2/3 lobe, there is minimal possibility of level Ⅱ lymph node metastasis.
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Affiliation(s)
- Tian Lv
- Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Clinical Research Center for Cancer of Zhejiang Province, 310014, Hangzhou, Zhejiang, China
| | - Wen-Li Ma
- Bengbu Medical College, Bengbu, Anhui, 233030, China
| | - Zhuo Tan
- Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Clinical Research Center for Cancer of Zhejiang Province, 310014, Hangzhou, Zhejiang, China
| | - Lie-Hao Jiang
- Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Clinical Research Center for Cancer of Zhejiang Province, 310014, Hangzhou, Zhejiang, China
| | - Ju-Yong Liang
- Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Clinical Research Center for Cancer of Zhejiang Province, 310014, Hangzhou, Zhejiang, China
| | - Jia-Jun Wu
- Bengbu Medical College, Bengbu, Anhui, 233030, China
| | - Chun-Jie Hou
- Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Cancer Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China
| | - Ming-Hua Ge
- Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Clinical Research Center for Cancer of Zhejiang Province, 310014, Hangzhou, Zhejiang, China.
| | - Jia-Feng Wang
- Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Clinical Research Center for Cancer of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Department of Thyroid and Breast Surgery, Zhejiang Provincial People's Hospital Bijie Hospital, Bijie, Guizhou, 551700, China.
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Ning Y, Liu Y, Zeng D, Zhou Y, Ma L, Dong S, Sheng J, Wu G, Tian W, Cai Y, Li C. Patterns of lymph node metastasis in level IIB and contralateral level VI for papillary thyroid carcinoma with pN1b and safety of low collar extended incision for neck dissection in level II. World J Surg Oncol 2023; 21:249. [PMID: 37592337 PMCID: PMC10433677 DOI: 10.1186/s12957-023-03075-w] [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: 11/14/2022] [Accepted: 06/14/2023] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVE To explore relevant clinical factors of level IIB and contralateral level VI lymph node metastasis and evaluate the safety of low-collar extended incision (LCEI) for lymph node dissection in level II for papillary thyroid carcinoma (PTC) with pN1b. METHOD A retrospective analysis was performed on 218 patients with PTC with pN1b who were treated surgically in the Head and Neck Surgery Center of Sichuan Cancer Hospital from September 2021 to May 2022. Data on age, sex, body mass index (BMI), tumor location, maximum tumor diameter, multifocality, Braf gene, T staging, surgical incision style, and lymph node metastasis in each cervical subregion were collected. The chi-square test was used for comparative analysis of relevant factors. All statistical analyses were completed by SPSS 24 software. RESULT Each subgroup on sex, age, BMI, multifocality, tumor location, extrathyroidal extension, Braf gene, and lymphatic metastasis in level III, level IV, and level V had no significant difference in the positive rate of lymph node metastasis in level IIB (P > 0.05). In contrast, patients with bilateral lateral cervical lymphatic metastasis were more likely to have level IIB lymphatic metastasis than those with unilateral lateral cervical lymphatic metastasis, with a statistically significant difference (P = 0.000). In addition, lymph node metastasis in level IIA was significantly associated with lymph node metastasis in level IIB (P = 0.001). After multivariate analysis, lymph node metastasis in level IIA was independently associated with lymph node metastasis in level IIB (P = 0.010). The LCEI group had a similar lymphatic metastasis number and lymphatic metastasis rate in both level IIA and level IIB as the L-shaped incision group (P > 0.05). There were 86 patients with ipsilateral central lymphatic metastasis (78.2%). Patients with contralateral central lymphatic metastasis accounted for 56.4%. The contralateral central lymphatic metastasis rate was not correlated with age, BMI, multifocality, tumor invasion, or ipsilateral central lymphatic metastasis, and there was no significant difference (P > 0.05). The contralateral central lymphatic metastasis in males was slightly higher than that in females, and the difference was statistically significant (68.2% vs. 48.5%, P = 0.041). CONCLUSION Lymphatic metastasis in level IIA was an independent predictor of lymphatic metastasis in level IIB. When bilateral lateral cervical lymphatic metastasis or lymph node metastasis of level IIA is found, lymph node dissection in level IIB is strongly recommended. When unilateral lateral cervical lymphatic metastasis and lymphatic metastasis in level IIA are negative, lymph node dissection in level IIB may be performed as appropriate on the premise of no damage to the accessory nerve. LCEI is safe and effective for lymph node dissection in level II. When the tumor is located in the unilateral lobe, attention should be given to contralateral central lymph node dissection because of the high lymphatic metastasis rate.
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Affiliation(s)
- Yudong Ning
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, , Chengdu, China
| | - Yuebai Liu
- Department of Head and Neck Surgery, Education & Training, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, China
| | - Dingfen Zeng
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, , Chengdu, China
| | - Yuqiu Zhou
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, , Chengdu, China
| | - Linjie Ma
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, , Chengdu, China
| | - Shuang Dong
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, , Chengdu, China
| | - Jianfeng Sheng
- Department of Thyroid, Head, Neck and Maxillofacial Surgery, The Third People's Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Gaosong Wu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wen Tian
- Department of General Surgery, Chinese PLA General Hospital, Beijing, China
| | - Yongcong Cai
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, , Chengdu, China.
| | - Chao Li
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, , Chengdu, China.
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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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Park JO, Kim JH, Joo YH, Kim SY, Kim GJ, Kim HB, Lee DH, Hong HJ, Park YM, Chung EJ, Ji YB, Oh KH, Lee HS, Lee DK, Park KN, Ban MJ, Kim BH, Kim DH, Cho JK, Ahn DB, Kim MS, Seok JG, Jang JY, Choi HG, Kim HJ, Park SJ, Jung EK, Kim YS, Hong YT, Lee YC, Won HR, Shin SC, Baek SK, Kwon SY. Guideline for the Surgical Management of Locally Invasive Differentiated Thyroid Cancer From the Korean Society of Head and Neck Surgery. Clin Exp Otorhinolaryngol 2023; 16:1-19. [PMID: 36634669 PMCID: PMC9985989 DOI: 10.21053/ceo.2022.01732] [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: 12/14/2022] [Accepted: 01/11/2023] [Indexed: 01/12/2023] Open
Abstract
The aim of this study was to develop evidence-based recommendations for determining the surgical extent in patients with locally invasive differentiated thyroid cancer (DTC). Locally invasive DTC with gross extrathyroidal extension invading surrounding anatomical structures may lead to several functional deficits and poor oncological outcomes. At present, the optimal extent of surgery in locally invasive DTC remains a matter of debate, and there are no adequate guidelines. On October 8, 2021, four experts searched the PubMed, Embase, and Cochrane Library databases; the identified papers were reviewed by 39 experts in thyroid and head and neck surgery. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of evidence, and to develop and report recommendations. The strength of a recommendation reflects the confidence of a guideline panel that the desirable effects of an intervention outweigh any undesirable effects, across all patients for whom the recommendation is applicable. After completing the draft guidelines, Delphi questionnaires were completed by members of the Korean Society of Head and Neck Surgery. Twenty-seven evidence-based recommendations were made for several factors, including the preoperative workup; surgical extent of thyroidectomy; surgery for cancer invading the strap muscles, recurrent laryngeal nerve, laryngeal framework, trachea, or esophagus; and surgery for patients with central and lateral cervical lymph node involvement. Evidence-based guidelines were devised to help clinicians make safer and more efficient clinical decisions for the optimal surgical treatment of patients with locally invasive DTC.
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Affiliation(s)
- Jun-Ook Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joo Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Young Hoon Joo
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Yeon Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Geun-Jeon Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Bum Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Hyun Lee
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Jun Hong
- Department of Otolaryngology-Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Young Min Park
- Department of Otolaryngology-Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Jae Chung
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Bae Ji
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Kyoung Ho Oh
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Hyoung Shin Lee
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
| | - Dong Kun Lee
- Department of Otolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Ki Nam Park
- Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Asan, Korea
| | - Myung Jin Ban
- Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Asan, Korea
| | - Bo Hae Kim
- Department of Otolaryngology-Head and Neck Surgery, Dongguk University College of Medicine, Goyang, Korea
| | - Do Hun Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Inje University, Busan, Korea
| | - Jae-Keun Cho
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Inje University, Busan, Korea
| | - Dong Bin Ahn
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Min-Su Kim
- Department of Otolaryngology-Head and Neck Surgery, CHA University School of Medicine, Seongnam, Korea
| | - Jun Girl Seok
- Department of Otolaryngology-Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Jeon Yeob Jang
- Department of Otolaryngology-Head and Neck Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Hyo Geun Choi
- Department of Otolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Hee Jin Kim
- Department of Otolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Sung Joon Park
- Department of Otolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Eun Kyung Jung
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School, Kwangju, Korea
| | - Yeon Soo Kim
- Department of Otolaryngology-Head and Neck Surgery, Konyang University College of Medicine, Daejeon, Korea
| | - Yong Tae Hong
- Department of Otolaryngology-Head and Neck Surgery, Jeonbuk National University Medical School, Jeonju, Korea
| | - Young Chan Lee
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Ho-Ryun Won
- Department of Otolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Korea
| | - Sung-Chan Shin
- Department of Otolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Seung-Kuk Baek
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Soon Young Kwon
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
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Huang C, Hu D, Zhuang Y, Su X. Risk factors and prediction model of level II lymph node metastasis in papillary thyroid carcinoma. Front Oncol 2022; 12:984038. [PMID: 36605444 PMCID: PMC9807902 DOI: 10.3389/fonc.2022.984038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Surgical management of lateral lymph nodes in papillary thyroid carcinoma, especially at level II, remains controversial. This study aimed to investigate the risk factors for level II lymph node metastasis in patients with papillary thyroid carcinoma and establish a prediction model to estimate the metastatic risk. Materials and methods A total of 768 patients with papillary thyroid carcinoma underwent thyroidectomy and central plus lateral lymph node dissection, including levels VI, II, III, and IV, at the First Affiliated Hospital of Chongqing Medical University from January 2016 to December 2018. Data on the clinicopathological characteristics were collected and analyzed. Univariate and multivariate analyses were performed to identify risk factors for level II lymph node metastasis. Subsequently, a predictive model was established based on the results of the multivariate analyses. Results The level II lymph node metastatic rate was 34.11% with the following features: largest tumor diameter >20 mm (Odds ratio=1.629, P=0.026), located in the upper pole (Odds ratio=4.970, P<0.001), clinical lymph node-positive (clinical central lymph node-positive: Odds ratio=1.797; clinical lateral lymph node-positive: Odds ratio=1.805, P=0.008), vascular invasion (Odds ratio=6.759, P=0.012), and rate of central lymph node metastasis (Odds ratio=2.498, P<0.001). Level III lymph node metastasis (Odds ratio=2.749, P<0.001) and level IV lymph node metastasis (Odds ratio=1.732, P=0.007) were independent of level II lymph node metastasis predictors. The prediction model's areas under the receiver operating characteristic curve were 0.815 and 0.804, based on bootstrapping validation. Level II lymph node metastasis was associated with the tumor-free survival rate of patients with papillary thyroid carcinoma (P<0.001). Conclusions Largest tumor diameter >20 mm, located in the upper pole, clinical lymph node-positive, vascular invasion, rate of central lymph node metastasis, and levels III and IV lymph node metastases were independent level II lymph node metastasis predictors. We developed a prediction model for level II lymph node metastasis. Overall, level II lymph node metastasis dissection should be individualized according to clinicopathological data both preoperatively and intraoperatively.
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Affiliation(s)
- Chun Huang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Daixing Hu
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuchen Zhuang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinliang Su
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,*Correspondence: Xinliang Su,
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Yang J, Zhang F, Qiao Y. Diagnostic accuracy of ultrasound, CT and their combination in detecting cervical lymph node metastasis in patients with papillary thyroid cancer: a systematic review and meta-analysis. BMJ Open 2022; 12:e051568. [PMID: 35788082 PMCID: PMC9255397 DOI: 10.1136/bmjopen-2021-051568] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To determine the diagnostic accuracy of ultrasound (US), CT and their combination in detecting cervical lymph node metastasis (CLNM) in patients with papillary thyroid cancer (PTC). METHODS Medline (via PubMed), Web of Science, Embase were searched to identify studies published till 5 December 2021 that used US and CT to detect CLNM in patients with PTC. The primary outcomes were sensitivity, specificity and diagnostic ORs in neck-level-based (lymph nodes are analysed by neck level) or patient-based (lymph nodes are analysed by patient) analysis. Secondary outcomes were sensitivity, specificity and DORs in the central and lateral compartments. RESULTS Fourteen studies (6167 patients with 11 601 neck lymph nodes) met the inclusion criteria. Based on the neck-level-based analysis, the pooled sensitivity, specificity and DORs were 0.35 (95% CI 0.34 to 0.37), 0.95 (95% CI 0.94 to 0.95) and 13.94 (95% CI 9.34 to 20.82) for US, were 0.46 (95% CI 0.44 to 0.47), 0.88 (95% CI 0.87 to 0.89) and 7.24 (95% CI 5.46 to 9.62) for CT, were 0.51 (95% CI 0.49 to 0.52), 0.85 (95% CI 0.84 to 0.86), 6.01 (95% CI 3.84 to 9.40) for the combination of US and CT. In the patient-based analysis, the pooled estimates of sensitivity, specificity and DOR were 0.41 (95% CI 0.36 to 0.46), 0.92 (95% CI 0.89 to 0.94) and 7.56 (95% CI 4.08 to 14.01) for US, were 0.49 (0.44 to 0.54), 0.91 (0.89 to 0.94), 9.40 (5.79 to 15.27) for CT, and were 0.64 (95% CI 0.57 to 0.71), 0.83 (95% CI 0.77 to 0.88), 8.59 (95% CI 5.37 to 13.76) for the combination of US and CT. DISCUSSION These findings suggest US, with a DOR almost twice that of CT in the neck-level-based analysis, was superior to CT in detecting CLNM in patients with PTC, especially in the lateral compartment. The combination of US and CT increased the sensitivity from 41%-49% for the individual modalities to 64% for combined modalities in the patient-based analysis.
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Affiliation(s)
- Jian Yang
- Department of Radiology, Taiyuan Xishan Hospital Co., Ltd, Taiyuan, Shanxi, China
| | - Fengyan Zhang
- Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Ying Qiao
- Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi, China
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Level IIb neck dissection guided by fine-needle aspiration for N1b papillary thyroid carcinoma. Surg Oncol 2022; 40:101705. [DOI: 10.1016/j.suronc.2021.101705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/14/2021] [Accepted: 12/28/2021] [Indexed: 11/22/2022]
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Song K, Jin Y, Kim M, Moon S, Heo DB, Won HR, Chang JW, Koo BS. Patterns of Occult Metastasis to Level Va and Vb in Clinically Lateral Node-Positive Papillary Thyroid Carcinoma. Ann Surg Oncol 2021; 29:2550-2556. [PMID: 34792697 DOI: 10.1245/s10434-021-11085-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The optimal extent of therapeutic lateral neck dissection (ND) in papillary thyroid carcinoma (PTC) continues to be debated. We analyzed the frequency, patterns, and predictive factors of occult level Va and Vb metastasis in clinically lateral node-positive PTC patients. METHODS We reviewed the data of PTC patients who underwent thyroidectomy and therapeutic lateral ND from level II to V between May 2008 and August 2020. In our study, 46 patients without clinically positive metastatic lymph nodes (LNs) at level V on the preoperative evaluation were included to analyze occult metastasis at level Va and Vb, respectively. Patient demographics, including age, sex, distribution of pathologic LNs, and characteristics of the primary tumors, were reviewed. In addition, clinicopathologic factors associated with occult level Va and Vb metastasis were analyzed. RESULTS Of the 46 patients, 14 (30.4%) patients had occult metastases at level Vb. No occult metastases were found at level Va. Clinically positive level II metastasis (p = 0.015) and simultaneous level II, III, and IV metastases (p = 0.010) in the preoperative evaluation were significantly associated with occult level Vb metastasis. Patients without LN metastasis at level IV or with three or fewer metastatic LNs in the lateral neck never had occult LN metastases at level Vb. CONCLUSIONS Occult metastasis at level Va is rare in PTC with lateral LN metastasis. Occult metastasis at level Vb may occur in PTC patients with multilevel involvement, including level II and/or four or more lateral LN metastases.
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Affiliation(s)
- Kunho Song
- Department of Otolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - YanLi Jin
- Department of Medical Science, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Mingyu Kim
- Department of Otolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Seongjun Moon
- Department of Otolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Da Beom Heo
- Department of Otolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Ho-Ryun Won
- Department of Otolaryngology-Head and Neck Surgery, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Jae Won Chang
- Department of Otolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Bon Seok Koo
- Department of Otolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Republic of Korea.
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Di Meo G, Prete FP, De Luca GM, Pasculli A, Sgaramella LI, Minerva F, Logoluso FA, Calculli G, Gurrado A, Testini M. The Value of Intraoperative Ultrasound in Selective Lateral Cervical Neck Lymphadenectomy for Papillary Thyroid Cancer: A Prospective Pilot Study. Cancers (Basel) 2021; 13:cancers13112737. [PMID: 34073149 PMCID: PMC8198597 DOI: 10.3390/cancers13112737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Lymph node metastases from papillary thyroid cancer (PTC) are frequent. Selective neck dissection (SND) is indicated in PTC with clinical or imaging evidence of lateral neck nodal disease. Both preoperative ultrasound (PreUS) and intraoperative palpation or visualization may underestimate actual lateral neck nodal involvement, particularly for lymph-nodes located behind the sternocleidomastoid muscle, where dissection may also potentially increase the risk of postoperative complications. The significance of diagnostic IOUS in metastatic PTC is under-investigated. (2) Methods: We designed a prospective diagnostic study to assess the diagnostic accuracy of IOUS compared to PreUS in detecting metastatic lateral neck lymph nodes from PTC during SND. (3) Results: There were 33 patients with preoperative evidence of lateral neck nodal involvement from PTC based on PreUS and fine-needle cytology. In these patients, IOUS guided the excision of additional nodal compartments that were not predicted by PreUS in nine (27.2%) cases, of which eight (24.2%) proved to harbor positive nodes at pathology. The detection of levels IIb and V increased, respectively, from 9% (PreUS) to 21% (IOUS) (p < 0.0001) and from 15% to 24% (p = 0.006). (4) Conclusions: In the context of this study, IOUS showed higher sensitivity and specificity than PreUS scans in detecting metastatic lateral cervical nodes. This study showed that IOUS may enable precise SND to achieve oncological radicality, limiting postoperative morbidity.
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Affiliation(s)
- Giovanna Di Meo
- Unit of Academic General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari, Polyclinic Hospital, 70124 Bari, Italy; (F.P.P.); (G.M.D.L.); (A.P.); (L.I.S.); (G.C.); (A.G.); (M.T.)
- Correspondence: ; Tel.: +39-3492123970
| | - Francesco Paolo Prete
- Unit of Academic General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari, Polyclinic Hospital, 70124 Bari, Italy; (F.P.P.); (G.M.D.L.); (A.P.); (L.I.S.); (G.C.); (A.G.); (M.T.)
| | - Giuseppe Massimiliano De Luca
- Unit of Academic General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari, Polyclinic Hospital, 70124 Bari, Italy; (F.P.P.); (G.M.D.L.); (A.P.); (L.I.S.); (G.C.); (A.G.); (M.T.)
| | - Alessandro Pasculli
- Unit of Academic General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari, Polyclinic Hospital, 70124 Bari, Italy; (F.P.P.); (G.M.D.L.); (A.P.); (L.I.S.); (G.C.); (A.G.); (M.T.)
| | - Lucia Ilaria Sgaramella
- Unit of Academic General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari, Polyclinic Hospital, 70124 Bari, Italy; (F.P.P.); (G.M.D.L.); (A.P.); (L.I.S.); (G.C.); (A.G.); (M.T.)
| | - Francesco Minerva
- Unit of Academic Internal Medicine “A. Murri”, Department of Biomedical Sciences and Human Oncology, University of Bari, Polyclinic Hospital, 70124 Bari, Italy;
| | - Francesco Antonio Logoluso
- Unit of Academic Endocrinology, Department of Emergency and Organ Transplantations, University of Bari, Polyclinic Hospital, 70124 Bari, Italy;
| | - Giovanna Calculli
- Unit of Academic General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari, Polyclinic Hospital, 70124 Bari, Italy; (F.P.P.); (G.M.D.L.); (A.P.); (L.I.S.); (G.C.); (A.G.); (M.T.)
| | - Angela Gurrado
- Unit of Academic General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari, Polyclinic Hospital, 70124 Bari, Italy; (F.P.P.); (G.M.D.L.); (A.P.); (L.I.S.); (G.C.); (A.G.); (M.T.)
| | - Mario Testini
- Unit of Academic General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari, Polyclinic Hospital, 70124 Bari, Italy; (F.P.P.); (G.M.D.L.); (A.P.); (L.I.S.); (G.C.); (A.G.); (M.T.)
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11
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Chebib E, Eymerit C, Chabbert-Buffet N, Angelard B, Lacau St Guily J, Périé S. High rate of IIA/IIB neck groups involvement supports complete lateral neck dissection in thyroid carcinoma. Gland Surg 2020; 9:1973-1981. [PMID: 33447547 DOI: 10.21037/gs-20-443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Although therapeutic lateral neck dissection (LND) may be indicated in thyroid carcinoma, the cervical lymph node groups IIA and IIB, according to Robbins classification, are often not removed. The aim of our study was to determine the relevance of complete comprehensive LND in thyroid carcinoma. Methods We conducted a retrospective study between January 2011 and August 2018 in a university teaching hospital. Histopathological analysis of LND performed during total thyroidectomy in thyroid carcinoma was reviewed according to lymph node level. To demonstrate that neck dissection of upper groups, IIA/IIB, is necessary when therapeutic LND is indicated in thyroid carcinoma, we compared histopathological involvement in complete comprehensive LND of the upper groups IIA/IIB to the lower groups III/IV/V. Results A total of 30 LND (24 patients) were suitable for analysis. Analysis by neck side revealed that comprehensive LND dissection samples were negative in 3 cases, and positive in 27. In those 27 positive LND, 15 demonstrated involvement of the groups IIA/IIB, and 12 were positive for involvement of the III/IV/V groups only. The combined presence of positive IIA/IIB and positive III/IV/V was observed in 15 of the 27 neck sides. There was no positive IIA/IIB without positive involvement of III/IV/V groups. Conclusions The high rate of positive cervical lymph nodes in the upper groups IIA/IIB supports complete comprehensive LND rather than selective III/IV/V LND in thyroid carcinoma surgery. However, impact on survival and whether postoperative radioactive iodine treatment may be modulated remain to be studied.
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Affiliation(s)
- Emilien Chebib
- Department of Otolaryngology Head and Neck Surgery, Tenon Hospital, Assistance Publique Hôpitaux de Paris (APHP), and Faculty Medicine Sorbonne University, Paris, France
| | - Caroline Eymerit
- Department of Pathology, Tenon Hospital, Assistance Publique Hôpitaux de Paris (APHP), and Faculty Medicine Sorbonne University, Paris, France
| | - Nathalie Chabbert-Buffet
- Department of Endocrinology and Reproductive Medicine, Pregnancy Associated Cancer Network, Tenon Hospital, Assistance Publique Hôpitaux de Paris (APHP), and Faculty Medicine Sorbonne University, Paris, France
| | - Bruno Angelard
- Department of Otolaryngology Head and Neck Surgery, Tenon Hospital, Assistance Publique Hôpitaux de Paris (APHP), and Faculty Medicine Sorbonne University, Paris, France
| | - Jean Lacau St Guily
- Department of Otolaryngology Head and Neck Surgery, Tenon Hospital, Assistance Publique Hôpitaux de Paris (APHP), and Faculty Medicine Sorbonne University, Paris, France.,Department of Otolaryngology Head and Neck Surgery, Rothschild Foundation, Paris, France
| | - Sophie Périé
- Department of Otolaryngology Head and Neck Surgery, Tenon Hospital, Assistance Publique Hôpitaux de Paris (APHP), and Faculty Medicine Sorbonne University, Paris, France.,Department of Otolaryngology Head and Neck Surgery, Com Maillot - Hartmann Clinic, Neuilly Sur Seine, France
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12
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Propst EJ, Wasserman JD, Gorodensky J, Ngan BY, Wolter NE. Patterns and Predictors of Metastatic Spread to the Neck in Pediatric Thyroid Carcinoma. Laryngoscope 2020; 131:E1002-E1009. [PMID: 32738066 DOI: 10.1002/lary.28937] [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: 05/02/2020] [Revised: 06/05/2020] [Accepted: 06/20/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Evaluate patterns and predictors of spread to the neck in pediatric metastatic differentiated thyroid carcinoma (DTC). METHODS Patients <18 years old undergoing thyroidectomy by a single surgeon from January 2015 to December 2019 were included. Neck sublevels were removed separately according to AJCC boundaries. Clinical outcomes included nerve injury, hypocalcemia, hematoma, and residual tumor. RESULTS Forty-eight children underwent thyroid surgery. Thirty (63%) were for malignancy, 27 (90%) of which were DTC. Nineteen (70%) patients with DTC underwent 24 neck dissections; 19 central plus lateral and 5 central alone. The female to male ratio increased from 1:1 to 3:1 with age. Two children with lateral neck involvement had sub-centimeter primaries. Patients requiring neck dissection were more likely to have 1) diffuse sclerosing or tall cell variant, 2) T3 or T4 disease, 3) genetic mutation, 4) lymphatic invasion, 5) extracapsular extension, 6) positive resection margin. Levels IIA (79%), III (89%), IV (84%), VI (100%) were most commonly involved. Levels IB (16%), IIB (16%), VB (16%) were also involved, often without involvement of adjacent levels. Permanent injuries included one unilateral recurrent laryngeal nerve, one mild marginal mandibular nerve and one mild accessory nerve. Hypocalcemia was highest following neck dissection for malignant disease. One patient was re-operated for a mediastinal node. Most patients with N1 disease received radioactive iodine. Most patients have no evidence or indeterminate disease on long-term follow-up. CONCLUSION Children with lateral nodal spread from DTC should be considered for neck dissection including Levels IB, IIA, IIB, III, IV, VB, bilateral VI. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1002-E1009, 2021.
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Affiliation(s)
- Evan Jon Propst
- Department of Otolaryngology - Head & Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Daniel Wasserman
- Division of Endocrinology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jonah Gorodensky
- Department of Otolaryngology - Head & Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Bo-Yee Ngan
- Department of Pediatric Laboratory Medicine, Division of Pathology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nikolaus Ernst Wolter
- Department of Otolaryngology - Head & Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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ÖZden S, çomçalι BÜL, Ataş H, Er S, Tez M, Saylam B. A Diagnostic Dilemma: Skip Metastasis in Papillary Thyroid Cancer. Am Surg 2020. [DOI: 10.1177/000313482008600335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The frequency, pattern, and predictive factors for skip LN metastasis in patients with papillary thyroid carcinoma (PTC) remain controversial. In this study, we evaluated predictive factors of skip LN metastasis in these patients. We reviewed the medical records of 68 PTC patients who underwent total thyroidectomy, central neck dissection, and lateral neck dissection at the initial operation. The relationships between skip LN metastasis and clinicopathologic factors were analyzed. After careful examination of electronic medical records of patients, 19 patients were excluded from the study. Of the remaining 49 patients, 9 (18.4%) had skip LN metastasis. Multivariate analysis showed that tumor size <1 cm was an independent risk factor for the presence of skip metastasis ( P = 0.035, odds ratio: 3.78, 95% confidence interval: 1.09–13.15). The rate of positive LN was relatively higher in micro-PTC patients than PTC patients. This finding is clinically significant and should be considered in routine clinical practice.
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Affiliation(s)
- Sabri ÖZden
- From the Department of Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - BÜLent çomçalι
- From the Department of Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Hakan Ataş
- From the Department of Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Sadettin Er
- From the Department of Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Mesut Tez
- From the Department of Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Barιş Saylam
- From the Department of Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
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Miličić B, Prstačić R, Prgomet D. Skip Metastases in Papillary Thyroid Carcinoma - Prevalence, Predictive and Clinicopathological Factors. Acta Clin Croat 2020; 59:122-128. [PMID: 34219894 PMCID: PMC8212598 DOI: 10.20471/acc.2020.59.s1.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Cervical lymph node metastases are frequently found in papillary thyroid carcinoma (PTC) and occur in a stepwise fashion. Skip metastases that omit the central compartment and spread initially in lateral neck levels are present in a certain share of patients, and their significance is poorly understood. The aim of this prospective study was to identify their possible predictors and clinicopathological factors in a group of patients with PTC with lateral lymph node (LLN) metastases. Methods We enrolled 68 patients with PTC with preoperatively evaluated LLN metastases who underwent total thyroidectomy with lateral lymph node dissection between 2011 and 2018. We analysed the clinicopathological features and pattern of dissemination of continuous and skip metastases. Results The prevalence of skip metastases was 23.5%. Compared with the continuous metastases group, the patients were older, had primary tumors that were more often situated unilaterally, and had smaller primary tumor size. Level II was less often involved, and none of the patients with skip metastases had all LNN positive (p = 0.05). Conclusion Skip metastases occur more frequently in older patients and display certain clinicopathological features like smaller size of the primary tumor and dissemination in less lateral neck levels. In the view of the fact that they are found rather frequently, lateral neck regions should be meticulously investigated in patients with PTC without central lymph node (CLL) metastases.
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Affiliation(s)
| | - Ratko Prstačić
- 1Department of Ear, Nose, Throat, and Head and Neck Surgery, Zagreb University Hospital Centre; 2School of Medicine, University of Zagreb
| | - Drago Prgomet
- 1Department of Ear, Nose, Throat, and Head and Neck Surgery, Zagreb University Hospital Centre; 2School of Medicine, University of Zagreb
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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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16
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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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Feng JW, Qin AC, Ye J, Pan H, Jiang Y, Qu Z. Predictive Factors for Lateral Lymph Node Metastasis and Skip Metastasis in Papillary Thyroid Carcinoma. Endocr Pathol 2020; 31:67-76. [PMID: 31828583 DOI: 10.1007/s12022-019-09599-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In papillary thyroid cancer (PTC) patients, cervical lymph node metastases are common, which disseminate sequentially from the central neck to the lateral neck. However, there is also a chaotic pattern of lymph node metastasis occasionally. In this study, we summarized 653 PTC patients who underwent thyroidectomy and central lymph node dissection with or without lateral lymph node dissection from two hospitals to investigate the pattern and risk factors of lateral lymph node metastasis (LLNM) and skip metastasis. LLNM was significantly associated tumor size > 1 cm, presence of extrathyroidal extension, tumors in the upper-lateral pole, and the number of metastatic lymph nodes in the central compartment. The frequency of skip metastasis was 22.5% (20 of 89 patients). Multivariate analyses showed tumor size ≤ 1 cm, and tumors in the upper-lateral pole were separately and independently associated with the risk of skip metastasis. Presence of LLNM affected the recurrence-free survival (RFS). RFS did not show the significantly difference between patients with LLNM and skip metastasis. Despite the low incidence of skip metastasis, attention should be paid to the possibility of LLNM even in the absence of central lymph node metastases. Besides, for patients with risk factors of LLNM or skip metastasis, detailed preoperative examination for the lateral compartment, especially the level III, is essential.
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Affiliation(s)
- Jia-Wei Feng
- The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - An-Cheng Qin
- The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Jing Ye
- The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - Hua Pan
- The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - Yong Jiang
- The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China.
| | - Zhen Qu
- The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
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18
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Qiu Y, Fei Y, Liu J, Liu C, He X, Zhu N, Zhao WJ, Zhu JQ. Prevalence, Risk Factors And Location Of Skip Metastasis In Papillary Thyroid Carcinoma: A Systematic Review And Meta-Analysis. Cancer Manag Res 2019; 11:8721-8730. [PMID: 31576174 PMCID: PMC6768127 DOI: 10.2147/cmar.s200628] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 08/13/2019] [Indexed: 02/05/2023] Open
Abstract
Background Skip metastasis is a special type in cervical lymph node metastasis (LNM) of patients diagnosed with papillary thyroid carcinoma (PTC) which induced poor prognosis. There are few studies about skip metastasis and conclusions remained uncertain. Therefore, this study aims to explore the frequency and to investigate risk factors of skip metastasis in PTC. Methods Through searching the keyword by PubMed and Embase databases which articles published up to 1st August 2018 about skip metastasis in papillary thyroid carcinoma, we extract data in order to assure whether those materials meet the criteria. Results The prevalence of skip metastasis is 12.02% in light of our meta-analysis of 18 studies with 2165 patients. The upper pole location (RR = 3.35, 95% CI =1.65-6.79, P = 0.0008) and tumors size ≤1 cm (RR = 2.65, 95% CI =1.50-4.70, P = 0.0008) are significantly associated with skip metastasis, whereas lymphovascular invasion (RR = 0.33, 95% CI =0.15-0.75, P = 0.0083) exists lower rate of skip metastasis. Multifocality, gender, age, bilaterality, thyroiditis and Extrathyroidal extension (ETE) are insignificantly associated with skip metastasis. Level II and level III are the most frequently affected areas. Conclusion The lateral compartment should be carefully examined especially for those PTC patients who present primary tumors in the upper lobe with a primary tumor size ≤10 mm which could be detected with skip metastasis.
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Affiliation(s)
- Yuxuan Qiu
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yuan Fei
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jingyan Liu
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Chang Liu
- Public Policy and Administration, Department of Government, London School of Economics and Political Science, London, UK
| | - Xin He
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Ning Zhu
- Library and Information Science, School of Information Management, Nanjing University, Nanjing, People's Republic of China
| | - Wan-Jun Zhao
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jing-Qiang Zhu
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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Attard A, Paladino NC, Lo Monte AI, Falco N, Melfa G, Rotolo G, Rizzuto S, Gulotta E, Salamone G, Bonventre S, Scerrino G, Cocorullo G. Skip metastases to lateral cervical lymph nodes in differentiated thyroid cancer: a systematic review. BMC Surg 2019; 18:112. [PMID: 31074393 PMCID: PMC7402576 DOI: 10.1186/s12893-018-0435-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/29/2018] [Indexed: 12/27/2022] Open
Abstract
Papillary thyroid carcinoma is a slow-growing cancer with a generally good prognosis that sometimes have an aggressive behaviour. Metastases to neck lymph nodes is the first step of the diffusion. The central neck compartment is involved most commonly. The ipsilateral lateral neck compartments are usually involved afterwards, and the involvement of the contralateral one is considered a quite rare occurrence. In more rare cases, metastases to lateral neck compartment without central lymph node metastasis (so called “skip metastases”) could be observed. Aim of this literature review study is to analyse the average incidence, pattern and risk factors of this occurrence. This study was performed according to PRISMA criteria. A final selection of 13 articles published in English language from 1997 to 2017 was performed. Any research article, review or meta-analysis was taken into consideration. Research was expanded considering the related references of articles. The incidence of skip metastases ranged from 1.6 to 21.8%. Risk factors such as age > 45 years, size < 5 mm and tumor located in the upper pole or isthmus of thyroid gland were found. Due to the frequency of skip metastases in thyroid cancer, a careful preoperative examination of lateral lymph nodes should be necessary.
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Affiliation(s)
- Andrea Attard
- Policlinico "P. Giaccone", Department of general emergency and transplant surgery, Unit of general and emergency surgery, Palermo, Italy
| | - Nunzia Cinzia Paladino
- Unit of General, Endocrine and Metabolic Surgery, CHU AP-HM Hôpital de la Conception (Marseille), 147 Boulevard Baille, 13385, Marseille cedex, France
| | - Attilio Ignazio Lo Monte
- Policlinico "P. Giaccone", Department of general emergency and transplant surgery, Unit of general and emergency surgery, Palermo, Italy
| | - Nicola Falco
- Policlinico "P. Giaccone", Department of general emergency and transplant surgery, Unit of general and emergency surgery, Palermo, Italy
| | - Giuseppina Melfa
- Policlinico "P. Giaccone", Department of general emergency and transplant surgery, Unit of general and emergency surgery, Palermo, Italy
| | - Giulia Rotolo
- Policlinico "P. Giaccone", Department of general emergency and transplant surgery, Unit of general and emergency surgery, Palermo, Italy
| | - Stefano Rizzuto
- Policlinico "P. Giaccone", Department of general emergency and transplant surgery, Unit of general and emergency surgery, Palermo, Italy
| | - Eliana Gulotta
- Policlinico "P. Giaccone", Department of general emergency and transplant surgery, Unit of general and emergency surgery, Palermo, Italy
| | - Giuseppe Salamone
- Policlinico "P. Giaccone", Department of general emergency and transplant surgery, Unit of general and emergency surgery, Palermo, Italy
| | - Sebastiano Bonventre
- Policlinico "P. Giaccone", Department of general emergency and transplant surgery, Unit of general and emergency surgery, Palermo, Italy
| | - Gregorio Scerrino
- Policlinico "P. Giaccone", Department of general emergency and transplant surgery, Unit of general and emergency surgery, Palermo, Italy.
| | - Gianfranco Cocorullo
- Policlinico "P. Giaccone", Department of general emergency and transplant surgery, Unit of general and emergency surgery, Palermo, Italy
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Lee CH, Lee SW, Son SH, Hong CM, Jeong JH, Jeong SY, Ahn BC, Lee J. PROGNOSTIC VALUE OF LYMPH NODE UPTAKE ON PRETREATMENT F-18 FDG PET/CT IN PATIENTS WITH N1B PAPILLARY THYROID CARCINOMA. Endocr Pract 2019; 25:787-793. [PMID: 31013158 DOI: 10.4158/ep-2018-0607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The aim of this study was to investigate the prognostic value of metabolic characteristics of metastatic lymph node (LN) using pretreatment F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for patients with papillary thyroid carcinoma (PTC) and metastatic lateral LN (N1b). Methods: Ninety-six PTC patients (female:male = 72:24; median age, 44.5 years) with pathologic N1b who underwent pretreatment FDG PET/CT, total thyroidectomy, and radioactive iodine ablation were retrospectively reviewed. To predict responses to initial therapy and recurrence, clinicopathologic factors and metabolic parameters were reviewed, such as sex, age, tumor size, extranodal extension, number and ratio of metastatic LNs, serum thyroglobulin, and maximum standardized uptake value (SUVmax). Results: Among the 96 PTC patients, 81 (84.4%) were classified into the acceptable response (58 excellent; 23 indeterminate) and 15 (15.6%) into the incomplete response (8 biochemical incomplete; 7 structural incomplete) by the 2015 American Thyroid Association management guideline for differentiated thyroid carcinoma. The multivariate analysis showed that SUVmax of N1b (P = .018), pre-ablation stimulated thyroglobulin level (P = .006), and the ratio of metastatic LNs (P = .018) were related to incomplete response. The cutoff value of each variable was determined by receiver operating characteristic analysis. Nine (9.4%) patients experienced recurrences (median follow-up: 50 months). The Kaplan-Meier analysis revealed that SUVmax of N1b (cutoff value: 2.3; P = .025) and ratio of metastatic LNs (cutoff value: 0.218; P = .037) were significant prognostic factors for recurrence. Conclusion: High SUVmax of N1b cervical LN on pretreatment FDG PET/CT could predict incomplete responses to initial therapy and recurrence in patients with N1b PTC. Abbreviations: ATA = American Thyroid Association; DTC = well-differentiated thyroid carcinoma; FDG = F-18 fluorodeoxyglucose; IQR = interquartile range; LN = lymph node; N1b = metastatic lateral cervical lymph node; PET/CT = positron emission tomography/computed tomography; PTC = papillary thyroid carcinoma; RAI = radioactive iodine; ROC = receiver operating characteristic; SUVmax = maximum standardized uptake value; Tg = thyroglobulin; USG = ultrasonography.
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Wang B, Weng Y, Wang S, Zhao W, Yan S, Zhang L, Wen J. Feasibility and safety of needle‐assisted endoscopic thyroidectomy with lateral neck dissection for papillary thyroid carcinoma: a preliminary experience. Head Neck 2019; 41:2367-2375. [PMID: 30775820 DOI: 10.1002/hed.25705] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/20/2019] [Accepted: 01/29/2019] [Indexed: 01/10/2023] Open
Affiliation(s)
- Bo Wang
- Department of Thyroid and Vascular SurgeryFujian Medical University Union Hospital Fuzhou Fujian China
| | - Yu‐jing Weng
- Department of Thyroid and Vascular SurgeryFujian Medical University Union Hospital Fuzhou Fujian China
| | - Si‐si Wang
- Department of Thyroid and Vascular SurgeryFujian Medical University Union Hospital Fuzhou Fujian China
| | - Wen‐xin Zhao
- Department of Thyroid and Vascular SurgeryFujian Medical University Union Hospital Fuzhou Fujian China
| | - Shou‐yi Yan
- Department of Thyroid and Vascular SurgeryFujian Medical University Union Hospital Fuzhou Fujian China
| | - Li‐yong Zhang
- Department of Thyroid and Vascular SurgeryFujian Medical University Union Hospital Fuzhou Fujian China
| | - Jia Wen
- Department of Thyroid and Vascular SurgeryFujian Medical University Union Hospital Fuzhou Fujian 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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Lei J, Zhong J, Jiang K, Li Z, Gong R, Zhu J. Skip lateral lymph node metastasis leaping over the central neck compartment in papillary thyroid carcinoma. Oncotarget 2018; 8:27022-27033. [PMID: 28223546 PMCID: PMC5432315 DOI: 10.18632/oncotarget.15388] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/16/2017] [Indexed: 02/05/2023] Open
Abstract
Objective This study was performed to investigate the frequency and pattern as well as the predictive factors of skip metastasis (lateral cervical lymph node metastasis without central lymph node metastasis) in papillary thyroid carcinoma (PTC). Methods 450 PTC patients who received total thyroidectomy with central neck dissection(CND) combined with modified radical lateral neck dissection(LND) were divided into two groups: with or without skip metastases. The clinicopathological characteristics were statistically compared and analyzed, and univariate and multivariate analyses were performed to detect the risk factors of skip metastasis. Results The skip metastasis rate was 8.7% (39/450), and patients with skip metastases had fewer lateral lymph node metastases but were more likely to have single-level lateral metastasis, which are considered Level II(P<0.05). Skip metastasis was significantly associated with the primary tumor location in the upper portion (OR=18.495, 95% CI 6.612-51.731), a primary tumor size ≤10mm (OR=32.492, 95% CI 11.973-88.174) and Capsule invasion (OR=5.822, 95% CI 1.954-17.343) as demonstrated by our prospective study of 10 patients who received an injection of 0.1 ml carbon nanoparticles under ultrasonography in the upper portion of the lobe: 7(70%) had lateral compartment lymph node black staining without ipsilateral center compartment lymph node staining. However, skip metastasis did not affect the PTC patients’ long-term tumor-free survival rate (P=0.432). Conclusion Skip metastases can be common, and the primary tumor location in the upper portion, a primary tumor size ≤10 mm, and capsular invasion are closely linked to skip metastasis. The lateral compartment should be carefully evaluated.
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Affiliation(s)
- Jianyong Lei
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Jinjing Zhong
- Department of Pathology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Ke Jiang
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Zhihui Li
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Rixiang Gong
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Jingqiang Zhu
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu 610041, China
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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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Skip metastasis in papillary thyroid carcinoma is difficult to predict in clinical practice. BMC Cancer 2017; 17:702. [PMID: 29070029 PMCID: PMC5657116 DOI: 10.1186/s12885-017-3698-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 10/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cervical lymph node metastases are very common in papillary thyroid cancer (PTC), and typically spread in a predictable stepwise fashion in clinical practice. However, lateral lymph node metastasis (LLNM) without central lymph node metastasis (CLNM) as skip metastasis is not rare in PTC. The aim of this study was to investigate the incidence, risk factors and pattern of skip metastasis in PTC. METHODS A total of 271 patients with PTC and suspicious LLN diagnosed by pre-operation examinations who underwent total thyroidectomy and central lymph node dissection plus lateral lymph node dissection between January 2008 and December 2011 were enrolled in this study. Clinicopathological features were collected, and the pattern of cervical lymph node metastasis and skip metastasis were analyzed. RESULTS The LLNM rate was 74.9% (203/271, diagnosed by postoperative pathology examination) and significantly associated with extrathyroid extension (ETE), primary tumor located at the upper pole, and CLNM (p < 0.05). The skip metastasis rate was 14.8% (30/203) and was more frequently found in microcarcinoma patients, especially when the primary tumor size was ≤0.5 cm (p = 0.001 OR = 12.9). However, skip metastasis was unrelated to the remaining factors examined. CONCLUSION Small cancers with a pre-operation diagnosis of LLNM are more likely to have skip metastases, especially when the primary tumor size is less than 0.5 cm in diameter; however, this type of metastasis appears to develop in a random fashion. Thus, additional research is needed to identify potential predictive factors, such as a primary tumor located at the upper pole.
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26
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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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Kaffenberger TM, Maxwell JH, Kim S. Prophylactic central neck dissection in 68 patients with lateral compartment metastases from well-differentiated thyroid cancer. Clin Otolaryngol 2017; 43:365-369. [PMID: 28834229 DOI: 10.1111/coa.12957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2017] [Indexed: 11/30/2022]
Affiliation(s)
- T M Kaffenberger
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - J H Maxwell
- Georgetown University School of Medicine, Washington, DC, USA
| | - S Kim
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Kim SK, Park I, Hur N, Choe JH, Kim JH, Kim JS. Patterns, predictive factors and prognostic impact of multilevel metastasis in N1b papillary thyroid carcinoma. Br J Surg 2017; 104:857-867. [PMID: 28295219 DOI: 10.1002/bjs.10514] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/18/2016] [Accepted: 01/28/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND The patterns, predictive factors and prognostic impact of multilevel metastasis in patients with N1b papillary thyroid carcinoma (PTC) were investigated. METHODS A retrospective review of patients with N1b PTC from a tertiary referral centre in Korea who underwent unilateral modified radical neck dissection was undertaken. RESULTS Of 658 patients, multilevel metastasis was found in 73·9 per cent; the most common type was metastasis in two levels. Tumour size per 0·1-cm increment (adjusted odds ratio (OR) 1·33, 95 per cent c.i. 1·08 to 1·64), microscopic extrathyroidal extension (adjusted OR 1·72, 1·10 to 2·71), gross extrathyroidal extension (adjusted OR 2·35, 1·24 to 4·46), unilateral central lymph node metastasis (adjusted OR 2·45, 1·53 to 3·92) and bilateral central lymph node metastasis (adjusted OR 4·06, 2·29 to 7·18) were independent predictors of multilevel metastasis. Only four-level metastasis significantly increased the risk of overall locoregional recurrence (LRR) (adjusted hazard ratio (HR) 7·41, 95 per cent c.i. 2·20 to 24·53) and lateral neck LRR (adjusted HR 7·22, 1·82 to 28·65), compared with one-level metastasis. Two subgroup analyses were conducted, showing that only three-level metastasis including metastasis in level V significantly increased the risk of overall LRR (adjusted HR 5·66, 1·20 to 26·75). In addition, having level V metastasis was an independent predictor of both overall (adjusted HR 3·26, 1·72 to 6·18; P < 0·001) and lateral neck (adjusted HR 3·28, 1·50 to 7·16; P = 0·003) LRR. CONCLUSION Level V metastasis rather than multilevel metastasis itself is associated with an increased risk of LRR. Patients with N1b PTC and level V metastasis require risk restratification and meticulous follow-up.
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Affiliation(s)
- S K Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea
| | - I Park
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea
| | - N Hur
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea
| | - J-H Choe
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea
| | - J-H Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea
| | - J S Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea
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Stang MT, Shah SA, Sosa JA. Management of the Central and Lateral Neck in Patients with Differentiated Thyroid Cancer. CURRENT SURGERY REPORTS 2016. [DOI: 10.1007/s40137-016-0147-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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30
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Jung JH, Kim CY, Son SH, Kim DH, Jeong SY, Lee SW, Lee J, Ahn BC. Preoperative Prediction of Cervical Lymph Node Metastasis Using Primary Tumor SUVmax on 18F-FDG PET/CT in Patients with Papillary Thyroid Carcinoma. PLoS One 2015; 10:e0144152. [PMID: 26636824 PMCID: PMC4670197 DOI: 10.1371/journal.pone.0144152] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 11/13/2015] [Indexed: 12/22/2022] Open
Abstract
Objectives The aim of the current study was to evaluate the value of preoperative 18F-FDG (FDG) PET/CT in predicting cervical lymph node (LN) metastasis in patients with papillary thyroid carcinoma (PTC). Methods One hundred and ninety-three newly diagnosed PTC patients (M: F = 25:168, age = 46.8 ± 12.2) who had undergone pretreatment FDG PET/CT and had neck node dissection were included in this study. The FDG avidity of the primary tumor and the SUVmax of the primary tumor (pSUVmax) were analyzed for prediction of LN metastasis. Detectability by ultrasonography (US) and FDG PET/CT for cervical LN metastasis were also assessed and compared with the pSUVmax. Results The FDG avidity of the primary tumor was identified in 118 patients (FDG avid group: 61.0%, M: F = 16:102, age 47.0 ± 12.7 years) and pSUVmax ranged from 1.3 to 35.6 (median 4.6) in the FDG avid group. The tumor size in the FDG avid group was bigger and there was a higher incidence of LN metastasis compared to the FDG non-avid group (0.93 vs. 0.59 cm, p <0.001 and 49.2 vs. 33.3%, p <0.05). In the FDG avid group, patients with LN metastasis had higher pSUVmax than patients without LN metastasis (8.7 ± 8.3 vs. 5.7 ± 5.1, p <0.001). The incidence of central LN metastasis in patients with a pSUVmax >4.6 was 54%; however, the detectability of central LN metastasis by US and FDG PET/CT were 10.3% and 3.6%, respectively. Conclusion A high FDG avidity of the primary tumor was related to LN metastasis in PTC patients. Therefore, patients with a high pSUVmax should be cautiously assessed for LN metastasis and might need a more comprehensive surgical approach.
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Affiliation(s)
- Ji-hoon Jung
- Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, Daegu, Republic of Korea
| | - Choon-Young Kim
- Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, Daegu, Republic of Korea
| | - Seung Hyun Son
- Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, Daegu, Republic of Korea
| | - Do-Hoon Kim
- Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, Daegu, Republic of Korea
| | - Shin Young Jeong
- Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, Daegu, Republic of Korea
| | - Sang-Woo Lee
- Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, Daegu, Republic of Korea
| | - Jaetae Lee
- Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, Daegu, Republic of Korea
| | - Byeong-Cheol Ahn
- Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, Daegu, Republic of Korea
- * E-mail:
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Xue S, Wang P, Liu J, Li R, Zhang L, Chen G. Prophylactic central lymph node dissection in cN0 patients with papillary thyroid carcinoma: A retrospective study in China. Asian J Surg 2015; 39:131-6. [PMID: 26117203 DOI: 10.1016/j.asjsur.2015.03.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 02/24/2015] [Accepted: 03/23/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE The objective of the study was to assess the patterns of central cervical lymph node metastasis (CLNM) and evaluate the prophylactic central lymph node dissection (CLND) in papillary thyroid carcinoma (PTC) patients without clinical positive lymph nodes. METHODS We retrospectively reviewed 1555 patients with PTC between 2003 and 2008. Lymph node metastatic risk factors and the pattern of lymph node metastasis in PTC were studied using multivariate analysis. RESULTS Male patients, aged ≤ 45 years, the presence of extrathyroidal extension, and a primary tumor size > 10 mm were identified as risk factors for CLNM with odds ratios of 2.089, 2.417, 1.534, and 3.079, respectively. Among 1555 patients, 97 cases (6.24%) had transient hypoparathyroidism, and only two patients (0.13%) had permanent hypoparathyroidism. Recurrent laryngeal nerve injury after thyroidectomy occurred in 14 patients (0.9%). In this group, nine cases were transient injury and the remaining five were permanent. During the period of follow-up, ranging from 5 years to 10 years, 18 patients (1.16%) were found with locoregional recurrence. CONCLUSION Taken together, in terms of the high incidence rate of CLNM in cN0 PTC patients, we believe that routine prophylactic CLND is optimal for clinically negative PTC patients, during their first treatment, especially for those with risk factors for CLNM.
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Affiliation(s)
- Shuai Xue
- Department of Thyroid Surgery, The First Hospital of Jilin University, NO. 71 XinMin Street, Changchun, People's Republic of China
| | - Peisong Wang
- Department of Thyroid Surgery, The First Hospital of Jilin University, NO. 71 XinMin Street, Changchun, People's Republic of China
| | - Jia Liu
- Department of Thyroid Surgery, The First Hospital of Jilin University, NO. 71 XinMin Street, Changchun, People's Republic of China
| | - Rui Li
- Department of Thyroid Surgery, The First Hospital of Jilin University, NO. 71 XinMin Street, Changchun, People's Republic of China
| | - Li Zhang
- Department of Thyroid Surgery, The First Hospital of Jilin University, NO. 71 XinMin Street, Changchun, People's Republic of China
| | - Guang Chen
- Department of Thyroid Surgery, The First Hospital of Jilin University, NO. 71 XinMin Street, Changchun, People's Republic of China.
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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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Kim WS, Koh YW, Byeon HK, Park YM, Chung HJ, Kim ES, Lee EJ, Park SC, Choi EC. Robot-assisted neck dissection via a transaxillary and retroauricular approach versus a conventional transcervical approach in papillary thyroid cancer with cervical lymph node metastases. J Laparoendosc Adv Surg Tech A 2014; 24:367-72. [PMID: 24742371 DOI: 10.1089/lap.2013.0296] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recently, robot-assisted neck dissection (ND) using a transaxillary approach in thyroid cancer patients with lateral neck metastases (LNM) was demonstrated to be feasible. The aim of this study was to compare the surgical outcomes of a modified transaxillary and retroauricular (TARA) versus a conventional transcervical approach in papillary thyroid carcinoma (PTC) patients with LNM. PATIENTS AND METHODS In total, 47 patients with PTC underwent total thyroidectomy with central compartment ND and modified radical ND except Level I. Twenty-two NDs were performed via the TARA approach, and 25 unilateral NDs were performed via the conventional transcervical approach. RESULTS The TARA and the open ND groups consisted of 22 and 25 patients, respectively. The operation time for ND in the TARA group was longer than that in the open ND group (209.4±38.2 minutes versus 143.1±30.5 minutes; P=.000). The mean scar satisfaction score in the TARA group was higher than in the conventional ND group (3.9±1.0 versus 2.8±1.0; P=.000). There were no differences in the mean number of retrieved lymph nodes. CONCLUSIONS The robot-assisted ND via the TARA approach can be an alternative option that produces excellent esthetic results for the management of LNM in PTC patients.
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Affiliation(s)
- Won Shik Kim
- 1 Department of Otorhinolaryngology, Yonsei University College of Medicine , Seoul, Korea
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Zhang XJ, Liu D, Xu DB, Mu YQ, Chen WK. Should level V be included in lateral neck dissection in treating papillary thyroid carcinoma? World J Surg Oncol 2013; 11:304. [PMID: 24274694 PMCID: PMC4222844 DOI: 10.1186/1477-7819-11-304] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 11/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study was designed to explore the regular patterns of level V lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC), and to indicate whether level V should be included in the management of lateral neck dissection when treating PTC. METHODS This retrospective study consisted of 330 patients diagnosed with PTC from January 1994 to July 2009 who underwent an operation that included therapeutic lateral neck dissection (levels II to V). The patterns of lateral neck LNM were analyzed and the relevant risk factors of level V LNM were analyzed with univariate and multivariate analysis, respectively. RESULTS All the patients underwent lateral neck dissection at levels II to V. The predominant site of metastasis was level III (247/330 (74.8%)), followed by level IV (233/330 (70.6%)), and level II (215/330 (65.3%)). Simultaneous multilevel involvement (level II, III, and IV) of lymphatic metastases presented in 46.1% (152/330) of the cases. Level V showed 28.8% (95/330) of nodal metastasis. Multivariate analysis showed that level V LNM was significantly associated with location (whole thyroid), gross extrathyroidal extension and simultaneous multilevel involvement (level II, III and IV). (P <0.05). CONCLUSIONS Due to relatively high rate of level V involvement and its correlation with location (whole thyroid), gross extrathyroidal extension and multilevel involvement, we consider that it may be more rational to include level V in the therapeutic lateral neck dissection when treating PTC, especially for those who have any one of these three independent risk factors.
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Affiliation(s)
- Xiao-Jun Zhang
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou 510060, P, R, China.
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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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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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Keum HS, Ji YB, Kim JM, Jeong JH, Choi WH, Ahn YH, Tae K. Optimal surgical extent of lateral and central neck dissection for papillary thyroid carcinoma located in one lobe with clinical lateral lymph node metastasis. World J Surg Oncol 2012; 10:221. [PMID: 23098385 PMCID: PMC3544686 DOI: 10.1186/1477-7819-10-221] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 10/15/2012] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The indications and extent of cervical lymph node dissection in papillary thyroid carcinoma (PTC) are still being debated. The aim of this study was to analyze the patterns of cervical lymph node metastasis in the lateral and central compartment and related factors and suggest the optimal extent of lateral and central neck dissection for PTC patients with clinical lateral lymph node metastasis. METHODS We retrospectively analyzed 72 patients with unilateral PTC who underwent therapeutic lateral neck dissections with concomitant total thyroidectomy and central neck dissection between January 2001 and December 2009. RESULTS The 72 patients underwent 79 sides of therapeutic lateral neck dissection. The most frequent metastatic level in the ipsilateral lateral compartment was level IV (75.0%), followed by level III (69.4%), level II (56.9%) and level V (20.8%). Multiple level metastases were common (77.8%) and were correlated with tumor size (≥ 10 mm). The central compartment lymph node metastasis rate was 87.5%, including 26.4% of contralateral central compartment metastases. CONCLUSION In PTC patients with clinical lateral lymph node metastasis, the optimal extent of lateral and central neck dissection should include levels II, III, IV and V as well as the bilateral central compartment.
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Affiliation(s)
- Hyo Sub Keum
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 133-792, Korea
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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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Guerrier B, Berthet JP, Cartier C, Dehesdin D, Edet-Sanson A, Le Clech G, Garrel R, Kania R, Makeieff M, Page C, Poirée S, Potard G, Prades JM, Righini C, Roussel F, Toubert ME. French ENT Society (SFORL) practice guidelines for lymph-node management in adult differentiated thyroid carcinoma. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 129:197-206. [PMID: 22883640 DOI: 10.1016/j.anorl.2012.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- B Guerrier
- ENT & Head Neck Surgery Department, University Hospital Center of Montpellier, 191 avenue du Doyen-Gaston-Giraud, Montpellier cedex, France
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Wu LM, Gu HY, Qu XH, Zheng J, Zhang W, Yin Y, Xu JR. The accuracy of ultrasonography in the preoperative diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma: A meta-analysis. Eur J Radiol 2012; 81:1798-805. [DOI: 10.1016/j.ejrad.2011.04.028] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 04/06/2011] [Indexed: 11/29/2022]
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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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Lim YC, Koo BS. Predictive factors of skip metastases to lateral neck compartment leaping central neck compartment in papillary thyroid carcinoma. Oral Oncol 2012; 48:262-5. [DOI: 10.1016/j.oraloncology.2011.10.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Revised: 10/07/2011] [Accepted: 10/07/2011] [Indexed: 11/26/2022]
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Gonzalez-Gonzalez R, Bologna-Molina R, Carreon-Burciaga RG, Gómezpalacio-Gastelum M, Molina-Frechero N, Salazar-Rodríguez S. Papillary thyroid carcinoma: differential diagnosis and prognostic values of its different variants: review of the literature. ISRN ONCOLOGY 2011; 2011:915925. [PMID: 22432054 PMCID: PMC3302055 DOI: 10.5402/2011/915925] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Accepted: 09/07/2011] [Indexed: 02/05/2023]
Abstract
Papillary thyroid carcinoma is the most common thyroid malignancy, and has an excellent prognosis, even with cervical lymph node metastasis; however, histological variants are considered relevant, which may be associated with familial adenomatous polyposis and tumor aggressiveness. Histological features, such as vascular and/or lymphatic invasion, angiogenesis, multifocality, high cellular proliferation rate, neoplastic cell dissemination, and the histological varieties, are indicative of poor prognosis, together with associated clinical factors: age, sex, and tumor size.
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Affiliation(s)
- Rogelio Gonzalez-Gonzalez
- Universidad Autónoma Metropolitana, México City, Mexico
- School of Dentistry, Research Department, Universidad Juárez del Estado de Durango (UJED), Durango, Mexico
| | - Ronell Bologna-Molina
- School of Dentistry, Research Department, Universidad Juárez del Estado de Durango (UJED), Durango, Mexico
| | - Ramón Gil Carreon-Burciaga
- School of Dentistry, Research Department, Universidad Juárez del Estado de Durango (UJED), Durango, Mexico
| | | | - Nelly Molina-Frechero
- Health Care Department, Universidad Autónoma Metropolitana, Xochimilco, Mexico City, Mexico
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The Accuracy of 18[F]-Fluoro-2-Deoxy-d-Glucose-Positron Emission Tomography/Computed Tomography, Ultrasonography, and Enhanced Computed Tomography Alone in the Preoperative Diagnosis of Cervical Lymph Node Metastasis in Patients with Papillary Thyroid Carcinoma. World J Surg 2010; 34:2564-9. [DOI: 10.1007/s00268-010-0733-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
BACKGROUND Personalizing treatment for papillary thyroid cancer (PTC) requires a multidisciplinary approach. The surgical management of PTC has long been based on retrospective studies focusing on endpoints that are of debatable significance. There is considerable debate in the literature regarding the optimal initial treatment for PTC. Many of these issues are discussed in this review. These debates have hindered the development of a tailored treatment strategy. SUMMARY The ability to optimally personalize a surgical plan for the treatment of PTC is ultimately dependent on an understanding of the biological behavior of that individual patient's tumor. We are at the genesis of an age where molecular biology advances endeavor to profile a patient's tumor behavior. This review summarizes current strategies for managing PTC, where we are with personalizing surgery for these patients, and where we hope to go. Thyroid surgery is one of the newest fields for the application of minimally invasive techniques and can now be accomplished endoscopically or with robotic assistance in many patients who therefore may benefit from these alternative approaches. CONCLUSION When treating a patient with PTC, it seems prudent to weigh the many factors discussed in this review to individualize the most optimal surgical plan.
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Affiliation(s)
- Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland 21287-0910, USA.
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Lee K, Kawata R, Nishikawa S, Yoshimura K, Takenaka H. Diagnostic criteria of ultrasonographic examination for lateral node metastasis of papillary thyroid carcinoma. Acta Otolaryngol 2010; 130:161-6. [PMID: 19479461 DOI: 10.3109/00016480903015143] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Considering the incidence of metastasis from papillary thyroid carcinoma (PTC) with respect to the lateral cervical regions and limited detection on preoperative ultrasonography (US), level II to IV dissection may be essential when lateral node metastasis (LNM) is detected on preoperative US. OBJECTIVES LNM is frequent in patients with PTC. However, a consensus regarding its preoperative diagnosis and the indication/extent of lateral node dissection (LND) has not been reached. We prepared criteria for diagnosing LNM from PTC using US. Furthermore, we investigated the usefulness and limits of US and appropriate extent of dissection. PATIENTS AND METHODS We conducted a retrospective study in 70 patients with PTC (80 sides) in whom LNM was detected preoperatively, and level II to V LND was performed. We compared the results of the preoperative diagnosis of LNM using US in accordance with the criteria with those of histopathological diagnosis after LND. RESULTS Diagnostic criteria for LNM were a minor axis of 6 mm or more and a minor/major axis ratio of 0.5 or more. Histopathologically, metastasis was detected in 467 lymph nodes. Of these, 199 (43%) were detected on US, and met the diagnostic criteria.
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Affiliation(s)
- Koutetsu Lee
- Department of Otolaryngology, Osaka Medical College, Osaka, Japan.
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Level IIb lymph node metastasis in thyroid papillary carcinoma. Eur Arch Otorhinolaryngol 2010; 267:1117-21. [DOI: 10.1007/s00405-009-1185-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2009] [Accepted: 12/16/2009] [Indexed: 10/20/2022]
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Is routine dissection of level II-B and V-A necessary in patients with papillary thyroid cancer undergoing lateral neck dissection for FNA-confirmed metastases in other levels. World J Surg 2009; 33:1680-3. [PMID: 19506945 DOI: 10.1007/s00268-009-0071-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The purpose of the present study was to determine the utility of routine dissection of level II-B and level V-A in patients with papillary thyroid cancer (PTC) undergoing lateral neck dissection for ultrasound-guided fine-needle aspiration (FNA)-confirmed lateral nodal metastasis in at least one neck nodal level. METHODS In a retrospective review, we studied the charts of 53 consecutive patients (February 2002-December 2007) with PTC who had undergone therapeutic lateral neck dissection that included at least level II-(A and B) and/or level V-(A and B). The levels were designated as such in situ prior to surgical pathology specimen processing. Reports of the preoperative FNA cytopathologic findings, the extent of lateral neck dissection by levels, and the postoperative final histopathologic examination were reviewed. RESULTS A total of 53 patients underwent therapeutic lateral neck dissection for FNA-confirmed nodal metastasis of PTC at a minimum of one lateral neck level. All 53 patients had preoperative ultrasonography and FNA confirmation of lateral neck disease: 46 patients had PTC, 5 had the tall cell variant of PTC, and 2 had the follicular variant of PTC on final surgical pathology. Ten patients underwent neck dissection at the time of thyroidectomy, and 43 patients underwent neck dissection for lateral neck recurrence/persistence of PTC following a previous thyroidectomy and radioactive iodine +/- previous neck dissection. A total of 46 patients underwent unilateral neck dissection and 7 patients underwent bilateral neck dissection; thus 60 neck dissection specimens were evaluated. Level II (A and B) was excised in 59/60 neck dissections, with 33 of 59 specimens (33/59 = 60%) positive for metastasis. Level II-B was positive 5 times (5/59; 8.5-95% CI: 2.4, 20.4), and each time level II-B was positive, level II-A was also grossly (and histopathologically--seen at the time of surgery) positive for metastasis. Level III was excised 58 times and was positive in 38 specimens (38/58 = 66%). Level IV was excised 58 times and was positive in 29 specimens (29/58 = 50%). Level V (A and B) was excised 40 times and was positive in 16 specimens (16-40 = 40%). Level V-A did not account for any of the positive level V results (0%). CONCLUSIONS Cervical lateral neck metastases in PTC occur in a predictable pattern, with levels III, II-A, and IV most commonly involved. Patients with PTC who undergo lateral neck dissection for FNA-confirmed nodal metastases might harbor disease in level II-B, especially if level II-A is involved. We recommend elective dissection of level II-B only when level II-A is involved, based on FNA confirmation, or when it is grossly involved on intraoperative evaluation. Routine dissection of level V-B is recommended in this patient population, while elective dissection of level V-A is not necessary.
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Ort S, Goldenberg D. Management of regional metastases in well-differentiated thyroid cancer. Otolaryngol Clin North Am 2009; 41:1207-18, xi. [PMID: 19040980 DOI: 10.1016/j.otc.2008.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Thyroid cancer represents the most common endocrine cancer, and rates have been increasing over the last 3 decades. The treatment of cervical metastases in well differentiated thyroid cancer remains in evolution. Many questions require further resolution. Unlike many other malignancies, most large studies have found that overall survival is not significantly affected by regional metastases. On the other hand, several studies have noted that regional disease may decrease survival in selected patient groups. The greatest effect of lymph node metastases seems to be an increase in recurrence rates. Except for the compartment-oriented removal of clinically positive nodes, few strong recommendations may be made.
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Affiliation(s)
- Stuart Ort
- Department of Otolaryngology-Head & Neck Surgery, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033-0850, USA
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