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Lin Y, Cui N, Li F, Wang Y, Wang B. The model for predicting the central lymph node metastasis in cN0 papillary thyroid microcarcinoma with Hashimoto's thyroiditis. Front Endocrinol (Lausanne) 2024; 15:1330896. [PMID: 38745958 PMCID: PMC11091240 DOI: 10.3389/fendo.2024.1330896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 04/08/2024] [Indexed: 05/16/2024] Open
Abstract
Background The relationship between Hashimoto's thyroiditis (HT) and papillary thyroid microcarcinoma (PTMC) is controversial. These include central lymph node metastasis (CLNM), which affects the prognosis of PTMC patients. This study aimed to establish a predictive model combining ultrasonography and clinicopathological features to accurately evaluate latent CLNM in PTMC patients with HT at the clinical lymph node-negative (cN0) stage. Methods In this study, 1102 PTMC patients who received thyroidectomy and central cervical lymph node dissection (CLND) from the First Affiliated Hospital of Shandong First Medical University from January 2021 to December 2022 and the 960th Hospital of PLA from January 2021 to December 2022 were jointly collected. The clinical differences between PTMCs with HT and those without HT were compared. A total of 373 PTMCs with HT in cN0 were randomly divided into a training cohort and a validation cohort. By analyzing and screening the risk factors of CLNM, a nomogram model was established and verified. The predictive performance was measured by the receiver operating characteristic (ROC) curve, calibration curve, and clinical decision curve analysis (DCA). Results The ratio of central lymph node metastasis (CLNMR) in PTMCs with HT was 0.0% (0.0%, 15.0%) and 7.7% (0.0%, 40.0%) in the non-HT group (P<0.001). Multivariate logistic regression analysis showed that age, gender, calcification, adjacent to trachea or capsule, and TPOAB were predictors of CLNM in PTMCs with HT. The areas under the curve (AUC) of the prediction models in the training cohort and the validation cohort were 0.835 and 0.825, respectively, which showed good differentiation ability. DCA indicates that the prediction model also has high net benefit and clinical practical value. Conclusion This study found that CLN involvement was significantly reduced in PTMC patients with HT, suggesting that different methods should be used to predict CLNM in PTMC patients with HT and without HT, to more accurately assist preoperative clinical evaluation. The actual CLNM situation of PTMCs with HT in cN0 can be accurately predicted by the combination of ultrasonography and clinicopathological features.
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Affiliation(s)
- Yuyang Lin
- Department of Ultrasound, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
| | - Na Cui
- Department of Medical Ultrasound, The 960th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Jinan, Shandong, China
| | - Fei Li
- Department of Ultrasound, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
| | - Yixuan Wang
- Department of Ultrasound, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
| | - Bei Wang
- Department of Ultrasound, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
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Kuczma P, Demarchi MS, Leboulleux S, Trésallet C, Mavromati M, Djafarrian R, Mabilia A, Triponez F. Central node dissection in papillary thyroid carcinoma in the era of near-infrared fluorescence. Front Endocrinol (Lausanne) 2023; 14:1110489. [PMID: 37124759 PMCID: PMC10140587 DOI: 10.3389/fendo.2023.1110489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/24/2023] [Indexed: 05/02/2023] Open
Abstract
The most common site of lymph node metastases in papillary thyroid carcinoma is the central compartment of the neck (level VI). In many patients, nodal metastases in this area are not clinically apparent, neither on preoperative imaging nor during surgery. Prophylactic surgical clearance of the level VI in the absence of clinically suspicious lymph nodes (cN0) is still under debate. It has been suggested to reduce local recurrence and improve disease-specific survival. Moreover, it helps to accurately diagnose the lymph node involvement and provides important staging information useful for tailoring of the radioactive iodine regimen and estimating the risk of recurrence. Yet, many studies have shown no benefit to the long-term outcome. Arguments against the prophylactic central lymph node dissection (CLND) cite minimal oncologic benefit and concomitant higher operative morbidity, with hypoparathyroidism being the most common complication. Recently, near-infrared fluorescence imaging has emerged as a novel tool to identify and preserve parathyroid glands during thyroid surgery. We provide an overview of the current scientific landscape of fluorescence imaging in thyroid surgery, of the controversies around the prophylactic CLND, and of fluorescence imaging applications in CLND. To date, only three studies evaluated fluorescence imaging in patients undergoing thyroidectomy and prophylactic or therapeutic CLND for thyroid cancer. The results suggest that fluorescence imaging has the potential to minimise the risk of hypoparathyroidism associated with CLND, while allowing to exploit all its potential benefits. With further development, fluorescence imaging techniques might shift the paradigm to recommend more frequently prophylactic CLND.
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Affiliation(s)
- Paulina Kuczma
- Department of Thoracic and Endocrine Surgery, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Marco Stefano Demarchi
- Department of Thoracic and Endocrine Surgery, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Sophie Leboulleux
- Department of Endocrinology, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Christophe Trésallet
- Assistance Publique–Hôpitaux de Paris, Department of Digestive, Bariatric and Endocrine Surgery, Bobigny Avicenne Hospital, Sorbonne Paris Nord University, Bobigny, France
| | - Maria Mavromati
- Department of Endocrinology, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Reza Djafarrian
- Department of Thoracic and Endocrine Surgery, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Andrea Mabilia
- Assistance Publique–Hôpitaux de Paris, Department of Digestive, Bariatric and Endocrine Surgery, Bobigny Avicenne Hospital, Sorbonne Paris Nord University, Bobigny, France
| | - Frédéric Triponez
- Department of Thoracic and Endocrine Surgery, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
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Parvathareddy SK, Siraj AK, Ahmed SO, DeVera F, Al-Sobhi SS, Al-Dayel F, Al-Kuraya KS. Risk Factors for Central Lymph Node Metastases and Benefit of Prophylactic Central Lymph Node Dissection in Middle Eastern Patients With cN0 Papillary Thyroid Carcinoma. Front Oncol 2022; 11:819824. [PMID: 35111686 PMCID: PMC8801573 DOI: 10.3389/fonc.2021.819824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/27/2021] [Indexed: 11/26/2022] Open
Abstract
Background Prophylactic central lymph node dissection (PCLND) for adult patients with papillary thyroid carcinoma (PTC) is still a matter of debate. Data on incidence, risk and benefits of PCLND in Middle Eastern patients is lacking. Therefore, we aimed to identify the incidence and predictive clinico-pathological and molecular marker of PCLND in adult patients with clinically node negative (cN0) Middle Eastern PTC. Methods This retrospective study included 942 adult Middle Eastern patients with cN0 PTC who underwent total thyroidectomy (TT) or TT+PCLND. Clinico-pathological associations of central lymph node metastasis (CLNM) were assessed. Multivariate analysis was performed using logistic regression and Cox proportional hazards model. Results 213 patients underwent PCLND and 38.0% (81/213) had positive CLNM. Multivariate analysis demonstrated age ≤55 years (Odds Ratio (OR) = 7.38; 95% Confidence Interval (CI) = 1.59 – 34.31; p = 0.0108), tumor bilaterality (OR = 3.01; 95% CI = 1.01 – 9.21; p = 0.0483), lymphovascular invasion (OR = 2.92; 95% CI = 1.18 – 7.23; p = 0.0206) and BRAF mutation (OR = 3.24; 95% CI = 1.41 – 7.49; p = 0.0058) were independent predictors of CLNM in adult PTC. Furthermore, patients who underwent PCLND showed significant association with improved recurrence-free survival (RFS; p = 0.0379). Multivariate analysis demonstrated that PCLND was an independent predictor of improved recurrence-free survival. Conclusions cN0 Middle Eastern PTC patients treated with PCLND showed a significantly better prognosis. PCLND was effective in improving RFS in Middle Eastern PTC patients and should be encouraged for patients with potential risk factors for CLNM.
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Affiliation(s)
- Sandeep Kumar Parvathareddy
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdul K Siraj
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saeeda O Ahmed
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Felisa DeVera
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saif S Al-Sobhi
- Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fouad Al-Dayel
- Department of Pathology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Khawla S Al-Kuraya
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Medas F, Canu GL, Cappellacci F, Anedda G, Conzo G, Erdas E, Calò PG. Prophylactic Central Lymph Node Dissection Improves Disease-Free Survival in Patients with Intermediate and High Risk Differentiated Thyroid Carcinoma: A Retrospective Analysis on 399 Patients. Cancers (Basel) 2020; 12:E1658. [PMID: 32585797 PMCID: PMC7353019 DOI: 10.3390/cancers12061658] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/08/2020] [Accepted: 06/20/2020] [Indexed: 12/15/2022] Open
Abstract
The role of prophylactic central lymph node dissection (pCLND) in the treatment of differentiated thyroid cancer (DTC) is controversial and still a matter of debate. The primary outcome of our study was to assess whether pCLND is effective in reducing the incidence of recurrent disease, and the secondary goal was to estimate the incidence of postoperative complications in patients who underwent pCLND and to evaluate the prognostic value of occult node metastases. In this retrospective study, we included patients with preoperative diagnosis of DTC and clinically uninvolved lymph nodes (cN0). The patients were divided into two groups, depending on the surgical approach: total thyroidectomy alone (TT group) or total thyroidectomy and pCLND (pCLND group). Three hundred and ninety-nine patients were included in this study, 320 (80.2%) in the TT group and 79 (19.8%) in the pCLND group. There were no significant differences in morbidity among the two groups. Histopathological evaluation demonstrated a similar distribution of aggressive features, especially regarding multicentricity, extrathyroidal extension, and angioinvasivity between the two groups. Occult lymph node metastases were found in 20 (25.3%) patients in the pCLND group. Prophylactic CLND was effective in improving disease-free survival in patients with intermediate and high risk of disease recurrence (p = 0.0392); occult lymph node metastases resulted as a significant negative prognostic factor (p < 0.001).
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Affiliation(s)
- Fabio Medas
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (G.L.C.); (F.C.); (G.A.); (E.E.); (P.G.C.)
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (G.L.C.); (F.C.); (G.A.); (E.E.); (P.G.C.)
| | - Federico Cappellacci
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (G.L.C.); (F.C.); (G.A.); (E.E.); (P.G.C.)
| | - Giacomo Anedda
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (G.L.C.); (F.C.); (G.A.); (E.E.); (P.G.C.)
| | - Giovanni Conzo
- Division of General and Oncologic Surgery, Department of Cardiothoracic Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Enrico Erdas
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (G.L.C.); (F.C.); (G.A.); (E.E.); (P.G.C.)
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (G.L.C.); (F.C.); (G.A.); (E.E.); (P.G.C.)
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Chen BD, Zhang Z, Wang KK, Shang MY, Zhao SS, Ding WB, Du R, Yu Z, Xu XM. A multivariable model of BRAF V600E and ultrasonographic features for predicting the risk of central lymph node metastasis in cN0 papillary thyroid microcarcinoma. Cancer Manag Res 2019; 11:7211-7217. [PMID: 31440100 PMCID: PMC6679677 DOI: 10.2147/cmar.s199921] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 07/04/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Prophylactic central lymph node dissection (CLND) in papillary thyroid microcarcinoma (PTMC) patients without clinical evidence of central lymph node metastasis (CLNM) remains controversial. The purpose of our study is to identify preoperative predictive factors for finding CLNM in Chinese PTMC patients, which may allow tailored CLND. Methods: We retrospectively reviewed 182 consecutive Chinese PMTC patients with negative central lymph nodes who underwent total thyroidectomy plus central neck dissection from October 2015 to December 2017. Chi-squared and multivariate analysis were performed to evaluate the association of CLNM with ultrasonographic and clinicopathologic characteristics. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the utility of markers in predicting CLNM. Results: The CLNM was found in 39.0% (71 of 182) of cN0 PTMC patients. In multivariate analysis, tumor size>7 mm (OR: 3.636, 95% CI: 1.671-7.914), marked hypoechogenicity (OR: 2.686, 95% CI: 1.080-6.678), multifocality (OR: 4.184, 95% CI: 1.707-10.258) and BRAFV600E mutation (OR: 5.339, 95% CI: 2.529-11.272) were independent predictors of CLNM. In ROC analysis integrating these predictors, the sensitivity was 63.4% and specificity was 80.2%, and the area under the ROC (AUC) was 0.755. Conclusion: In conclusion, we found tumor size>7 mm, marked hypoechogenicity, multifocality, and BRAFV600E mutation were risk factors for CLNM. In term of these preoperative risk factors for CLNM, prophylactic CLND should be cautiously performed in cN0 PTMC patients.
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Affiliation(s)
- Bao-Ding Chen
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang 212000, People's Republic of China
| | - Zheng Zhang
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang 212000, People's Republic of China
| | - Ke-Ke Wang
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang 212000, People's Republic of China
| | - Meng-Yuan Shang
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang 212000, People's Republic of China
| | - Shuang-Shuang Zhao
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang 212000, People's Republic of China
| | - Wen-Bo Ding
- Department of Medical Ultrasound, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing 210028, People's Republic of China
| | - Rui Du
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang 212000, People's Republic of China
| | - Zhuan Yu
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang 212000, People's Republic of China
| | - Xi-Ming Xu
- Department of Pharmaceutics, School of Pharmacy and Center for Drug/Gene Delivery and Tissue Engineering, Jiangsu University, Zhenjiang, Jiangsu 212001, People's Republic of China
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Tao Y, Wang C, Li L, Xing H, Bai Y, Han B, Liu Z, Yang X, Zhu S. Clinicopathological features for predicting central and lateral lymph node metastasis in papillary thyroid microcarcinoma: Analysis of 66 cases that underwent central and lateral lymph node dissection. Mol Clin Oncol 2016; 6:49-55. [PMID: 28123728 PMCID: PMC5244859 DOI: 10.3892/mco.2016.1085] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 11/08/2016] [Indexed: 12/13/2022] Open
Abstract
Currently the surgical approach for papillary thyroid microcarcinoma (PTMC), particularly the range of lymph node dissection, remains controversial. The present study aims to evaluate the risk factors for central and lateral lymph node metastasis (CLNM and LLNM) for appropriate clinical decision of neck lymph node dissection in PTMC. A total of 66 cases of PTMC that underwent unilateral or bilateral lobectomy plus prophylactic cervical lymph node dissection were collected for clinicopathological evaluation, including age, gender, tumor size, subtypes, extrathyroidal invasion, multifocality, calcifications, loss of cellular polarity/cohesiveness (LOP/C) in the invasive front, CLNM and LLNM, and retrospectively analysis. Univariate analysis revealed that LOP/C was significantly associated with CLNM (P=0.001) and LLNM (P<0.0001). The male gender was a risk factor of CLNM (P=0.04), while the age <45 years, tumor size >0.5 cm and multifocality were high-risk factors of LLNM (P=0.022, 0.044 and 0.005, respectively). Multivariable analysis revealed that LOP/C was significantly associated with CLNM [P=0.007, odds ratio (OR)=7.765, 95% confidence interval (CI)=1.773–33.996] and LLNM [P=0.029, OR=5.717, 95% CI=1.190–27.470]. Both multivariable analysis and χ2 test revealed that CLNM was another important high-risk factor of LLNM (P=0.021, OR=5.444, 95% CI=1.290–22.969, χ2=17.867, P<0.001). The present study revealed that prophylactic central lymph node dissection is essential for PTMC surgery and that prophylactic lateral lymph node dissection is recommend for patients with LOP/C and CLNM, which can be performed by intraoperative frozen section pathological examination. This must be considered discreetly in the case of patients with age <45 years, tumor size >0.5 cm and multifocal lesions.
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Affiliation(s)
- Yang Tao
- Department of Head and Neck, Affiliated Hospital of Shandong Medical Sciences, Jinan, Shandong 250031, P.R. China
| | - Chongjie Wang
- Department of Head and Neck, Affiliated Hospital of Shandong Medical Sciences, Jinan, Shandong 250031, P.R. China
| | - Liye Li
- Department of Head and Neck, Affiliated Hospital of Shandong Medical Sciences, Jinan, Shandong 250031, P.R. China
| | - Haijun Xing
- Department of Head and Neck, Affiliated Hospital of Shandong Medical Sciences, Jinan, Shandong 250031, P.R. China
| | - Yun Bai
- Department of Head and Neck, Affiliated Hospital of Shandong Medical Sciences, Jinan, Shandong 250031, P.R. China
| | - Bing Han
- Department of Head and Neck, Affiliated Hospital of Shandong Medical Sciences, Jinan, Shandong 250031, P.R. China
| | - Zhiyan Liu
- Department of Pathology, Qilu Hospital, Jinan, Shandong 250012, P.R. China
| | - Xiangshan Yang
- Department of Pathology, Affiliated Hospital of Shandong Medical Sciences, Jinan, Shandong 250031, P.R. China
| | - Shourong Zhu
- Department of Head and Neck, Affiliated Hospital of Shandong Medical Sciences, Jinan, Shandong 250031, P.R. China
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