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Peng L, Zheng X, Xue Y, Huang C, Su X, Yu S. Central lymph nodes in frozen sections can effectively guide extended lymph node resection for papillary thyroid carcinoma. Ann Med 2023; 55:2286337. [PMID: 38061392 PMCID: PMC10836250 DOI: 10.1080/07853890.2023.2286337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES The scope of lateral neck lymph node dissection (LND) in papillary thyroid carcinoma (PTC) remains controversial. Our research aimed to explore the value of central lymph node metastasis (CLNM) in frozen sections for predicting neck lateral lymph node metastasis (NLLNM) and to guide clinical surgeons in performing surgical lymph node dissection. PATIENTS A total of 275 patients with PTC with suspected 'Cervical lymph node metastasis (LNM, including CLNM and NLLNM)' underwent unilateral or bilateral thyroidectomy and an intraoperative frozen diagnosis of central lymph nodes (LNs), as well as central and neck lateral LND. Validity indices and consistency of central LNs in frozen sections were calculated. In total, 216 patients then met the inclusion criteria and were enrolled in the follow-up study. The clinical and pathological data of the patients were retrospectively analyzed. The relationship between the number, metastatic diameter, and the ratio of CLNM to NLLNM was investigated. RESULTS CLNM in frozen and paraffin-embedded sections was associated with NLLNM. Univariate and multivariate analyses revealed the following risk factors for NLLNM metastasis: maximum diameter, total number, and ratio of metastatic LNs. A significant result was obtained when a cut-off value of 2.050 mm for the maximum metastatic diameter, 5.5 in the total number, and 0.5342 for the CLNM ratio level was used. Interaction term analyses showed that the association between the number of CLNM and NLLNM differed according to maximum diameter. CONCLUSION Central LNs in frozen sections accurately predicted NLLNM. In patients with PTC with >5 CLNMs, ≥2 and ≤5 CLNMs and maximum metastatic diameter > 2 mm, neck lateral LND should be considered. Our findings will facilitate the identification of patients who are likely to benefit from extended lateral neck LND.
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Affiliation(s)
- Li Peng
- Department of Pathology, College of Basic Medicine, Molecular Medicine Diagnostic and Testing Center, Chongqing Medical University, Chongqing, China
| | - Xiaoya Zheng
- Department of Endocrinology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Xue
- Department of Pathology, College of Basic Medicine, Molecular Medicine Diagnostic and Testing Center, Chongqing Medical University, Chongqing, China
| | - Chun Huang
- Department of Thyroid and Breast Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - XinLiang Su
- Department of Thyroid and Breast Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shanshan Yu
- Department of Pathology, College of Basic Medicine, Molecular Medicine Diagnostic and Testing Center, Chongqing Medical University, Chongqing, China
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Tang L, Qu RW, Park J, Simental AA, Inman JC. Prevalence of Occult Central Lymph Node Metastasis by Tumor Size in Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis. Curr Oncol 2023; 30:7335-7350. [PMID: 37623013 PMCID: PMC10453273 DOI: 10.3390/curroncol30080532] [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: 05/01/2023] [Revised: 06/09/2023] [Accepted: 07/21/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND While papillary thyroid carcinoma (PTC) is associated with high occult central neck metastasis (CNM) rates, prophylactic central neck dissection (pCND) is controversial. This meta-analysis aims to look at the occult CNM rate according to tumor size. METHODS A literature search was conducted in PubMed from inception to April 2023. Inclusion criteria were primary studies that determined occult CNM rates in cN0 PTC by tumor size. Heterogeneity, influential case diagnostics, and proportion data were evaluated with Cochran's Q-test, Baujat plots and Forest plots, respectively. RESULTS Fifty-two studies were included in this meta-analysis. The findings demonstrated an occult CNM rate of 30.3% for tumors ≤ 5 mm, 32.7% for tumors ≤ 1 cm, 46.0% for tumors between 1 and 2 cm, 43.1% for tumors between 2 and 4 cm, and 61.2% for tumors > 4 cm. The heterogeneity of each study group was high, though no publication bias was noted. While there was a trend towards increased occult CNM rates with larger tumors, comparisons between different size cutoffs varied in significance. CONCLUSION This comprehensive review affirms that occult CNM is high and that an ipsilateral pCND can be justified in all PTC patients for accurate differentiation between Stage I and Stage II disease and its clinical implications.
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Affiliation(s)
- Liyang Tang
- Department of Otolaryngology—Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA 92354, USA (J.C.I.)
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Mechera R, Maréchal-Ross I, Sidhu SB, Campbell P, Sywak MS. A Nod to the Nodes: An Overview of the Role of Central Neck Dissection in the Management of Papillary Thyroid Carcinoma. Surg Oncol Clin N Am 2023; 32:383-398. [PMID: 36925192 DOI: 10.1016/j.soc.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Lymph node metastasis in thyroid cancer is common and associated with an increased risk of locoregional recurrence (LRR). Although therapeutic central neck dissection is well established, prophylactic central node dissection (pCND) for microscopic occult nodal involvement is controversial and recommendations are based on low-level evidence. The potential benefits of pCND such as reducing LRR and re-operation, refining staging, and improving surveillance are enthusiastically debated and the decision to perform pCND must be weighed up against the increased risks of complications.
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Affiliation(s)
- Robert Mechera
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, St. Leonards, New South Wales 2065, Australia; Clarunis, University Hospital Basel, Spitalstrasse 21, Basel 4031, Switzerland; Endocrine and Breast Surgery, St. George Hospital, Gray Street, Kogarah, New South Wales 2217, Australia.
| | - Isabella Maréchal-Ross
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, St. Leonards, New South Wales 2065, Australia
| | - Stan B Sidhu
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, St. Leonards, New South Wales 2065, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales 2006, Australia
| | - Peter Campbell
- Endocrine and Breast Surgery, St. George Hospital, Gray Street, Kogarah, New South Wales 2217, Australia
| | - Mark S Sywak
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, St. Leonards, New South Wales 2065, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales 2006, Australia
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Clinical Value of Ultrasonography and Serum Markers in Preoperative N Staging of Thyroid Cancer. Cells 2022; 11:cells11223621. [PMID: 36429049 PMCID: PMC9688687 DOI: 10.3390/cells11223621] [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: 10/21/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
We aimed to determine factors influencing lymph node metastasis (LNM) and develop a more effective method to assess preoperative N staging. Overall, data of 2130 patients who underwent thyroidectomy for thyroid cancer between 2018 and 2021 were retrospectively analysed. Patients were divided into groups according to pN0, pN1a, and pN1b stages. Pathology was used to analyse the correlation between preoperative serum marker indicators and LNM. Receiver operating characteristic curves were used to compare the diagnostic value of ultrasound (US) examination alone, serum thyroglobulin, age, and combined method for LNM. A significant moderate agreement was observed between preoperative US and postoperative pathology for N staging. Between the pN0 and pN1 (pN1a + pN1b) groups, the differences in free triiodothyronine, anti-thyroid peroxidase antibody, and serum thyroglobulin levels were statistically significant. Among the indicators, serum thyroglobulin was an independent predictor of LNM. The area under the receiver operating characteristic curve was 0.610 for serum thyroglobulin level for predicting LNM, 0.689 for US alone, and 0.742 for the combined method. Both preoperative US and serum thyroglobulin level provide a specific value when evaluating the N staging of thyroid cancer, and the combined method is more valuable in the diagnosis of LNM than US alone.
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Zhou J, Li DX, Gao H, Su XL. Relationship between subgroups of central and lateral lymph node metastasis in clinically node-negative papillary thyroid carcinoma. World J Clin Cases 2022; 10:3709-3719. [PMID: 35647144 PMCID: PMC9100740 DOI: 10.12998/wjcc.v10.i12.3709] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/08/2021] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lymph node metastasis (LNM) of papillary thyroid carcinoma (PTC) has a certain regularity and occurs first to the central lymph node and then to the lateral lymph node. The pathway of PTC LNM can guide surgical prophylactic lymph node dissection (LND) for clinical surgeons.
AIM To investigate the relationship between subgroups of central LNM and lateral LNM in unilateral clinically node-negative PTC (cN0-PTC).
METHODS Data were collected for 1089 PTC patients who underwent surgical treatment at the Department of Endocrine and Breast Surgery of the First Hospital of Chongqing Medical University from January 2016 to December 2017. A total of 388 unilateral cN0-PTC patients met the inclusion criteria and were enrolled in this study. The clinical and pathological data for these 388 patients who underwent total thyroidectomy + central LND + lateral LND were retrospectively analyzed. The relationship between the central LNM and lateral LNM subgroups was investigated.
RESULTS The coincidence rate of cN0-PTC was only 30.0%.Optimal scaling regression analysis showed that sex (57.1% vs 42.9%, P = 0.026), primary tumor size (68.8% vs 31.2%, P = 0.008), tumor location (59.7% vs 40.3%, P = 0.007), extrathyroid extension (ETE) (50.6% vs 49.9%, P = 0.046), and prelaryngeal LNM (57.1% vs 42.9%, P = 0.004) were significantly associated with ipsilateral level-II LNM. Their importance levels were 0.122, 0.213, 0.172, 0.110, and 0.227, respectively. Primary tumor size (74.6% vs 30.2%, P = 0.016), pretracheal LNM (67.5% vs 32.5%, P < 0.001), and paratracheal LNM (71.4% vs 28.6%, P < 0.001) were significantly associated with ipsilateral level-III LNM. Their importance levels were 0.120, 0.408, and 0.351, respectively. Primary tumor size (72.1% vs 27.9%, P = 0.003), ETE (70.4% vs 29.6%, P = 0.016), pretracheal LNM (68.3% vs 31.7%, P=0.001), and paratracheal LNM (80.8% vs 19.2%, P < 0.001) were significantly associated with ipsilateral level-IV LNM. Their importance levels were 0.164, 0.146, 0.216, and 0.472, respectively.
CONCLUSION The LNM pathway of thyroid cancer has a certain regularity. For unilateral cN0-PTC patients with a tumor diameter > 2 cm and pretracheal or ipsilateral paratracheal LNM, LND at ipsilateral level III and level IV must be considered. When there is a tumor in the upper third of the thyroid with prelaryngeal LNM, LND at level II, level III and level IV must be considered.
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Affiliation(s)
- Jing Zhou
- Department of Thyroid and Breast Surgery, Chongqing Health Center for Women and Children, Chongqing 401120, China
| | - Da-Xue Li
- Department of Thyroid and Breast Surgery, Chongqing Health Center for Women and Children, Chongqing 401120, China
| | - Han Gao
- Department of Thyroid and Breast Surgery, Chongqing Health Center for Women and Children, Chongqing 401120, China
| | - Xin-Liang Su
- Department of Thyroid and Breast Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Zhao L, Wu F, Zhou T, Lu K, Jiang K, Zhang Y, Luo D. Risk factors of skip lateral cervical lymph node metastasis in papillary thyroid carcinoma: a systematic review and meta-analysis. Endocrine 2022; 75:351-359. [PMID: 35067901 DOI: 10.1007/s12020-021-02967-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/11/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To analyze and explore the risk factors of skip lateral cervical lymph node metastasis (SLLNM) in papillary thyroid carcinoma (PTC). METHODS PubMed, Web of Science, Embase, Cochrane, Wanfang, China National Knowledge Infrastructure, and China Science and Technology Journal databases, updated to April 4, 2021, were systematically searched for literature on the risk factors of SLLNM in PTC. The meta-analysis was completed using Stata 15.0 software after quality evaluation. The odds ratio (OR) and 95% confidence interval (CI) of each variable were calculated using fixed or random-effects models, and the publication bias was evaluated by the Egger's test. RESULTS A total of 28 studies with 10,682 cases were included in our meta-analysis; 1592 (14.90%) cases were positive for SLLNM. The meta-analysis showed that female sex (OR = 1.16, 95% CI = 1.02-1.31, P = 0.021), age ≥45 (OR = 1.60, 95% CI = 1.19-2.15, P = 0.002), tumor diameter ≤10 mm (OR = 2.23, 95% CI = 1.62-3.06, P < 0.001), and upper location of tumor (OR = 3.60, 95% CI = 2.65-4.89, P < 0.001) were risk factors for SLLNM in PTC patients. Hashimoto's thyroiditis (OR = 1.02, 95% CI = 0.88-1.19, P = 0.777), multifocality (OR = 0.98, 95% CI = 0.75-1.28, P = 0.873), bilateral tumors (OR = 0.92, 95% CI = 0.70-1.19, P = 0.515), extrathyroidal extensions (OR = 1.07, 95% CI = 0.83-1.39, P = 0.598), and capsular invasion (OR = 0.93, 95% CI = 0.65-1.31, P = 0.660) were not closely related to SLLNM risk. CONCLUSION This study confirmed significant associations between SLLNM and female sex, age ≥45, tumor diameter ≤10 mm, and upper location of the tumor.
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Affiliation(s)
- Lingqian Zhao
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Fan Wu
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Tianhan Zhou
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Kaining Lu
- Department of Surgical Oncology, Affiliated Hangzhou First People's Hospital Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Kecheng Jiang
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Yu Zhang
- Department of Surgical Oncology, Affiliated Hangzhou First People's Hospital Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Dingcun Luo
- Department of Surgical Oncology, Affiliated Hangzhou First People's Hospital Zhejiang University School of Medicine, Hangzhou, 310006, China.
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