Clinical impact of cervical lymph node involvement and central neck dissection in patients with papillary thyroid carcinoma: a retrospective analysis of 368 cases

Abstract

The impact of cervical lymph node metastases and the optimal surgical management of the neck in patients with papillary thyroid carcinoma (PTC) remain controversial. The objectives of this retrospective study were to determine, in patients with PTC, the predictive factors and the impact on tumor recurrence rate of cervical lymph node involvement, and to evaluate the oncologic results and the morbidity of central neck dissection (CND). We reviewed the records of patients who had undergone surgical treatment for PTC at our institution between 1990 and 2000. A total of 368 patients (86 men and 282 women) were included in this study. Young age (p = 0.02), tumor size (p = 0.001) and extrathyroidal tumor extension (p = 0.003) were significant predictive factors of cervical lymph node metastatic involvement (multivariate analysis). Initial metastatic cervical lymph node involvement was identified as an independent risk factor of tumor recurrence (multivariate analysis, p = 0.01). Metastatic lymph node(s) were found in prophylactic CND specimens in 31% of the patients. CND increased the risk of postoperative hypocalcemia (p = 0.008) and of permanent hypoparathyroidism (p = 0.002). In conclusion, cervical lymph node metastatic involvement at the time of initial surgery is an independent risk factor of tumor recurrence. CND provided an up-staging of more than 30% of patients with a clinically N0 neck, but was associated with significant morbidity regarding parathyroid function.

Clinicopathological, immunohistochemical factors and recurrence associated with extrathyroidal extension in papillary thyroid microcarcinoma

“…[50] Prevalence of the central lymph node metastasis in clinically node negative PTMC has been reported to be as great as 30-65% and there may be some impact on recurrence in the neck requiring further surgical treatment, although the presence of microscopic nodal metastasis has not been shown to have a major impact on outcome. [51][52][53] Prophylactic CLND may be performed in patients with clinically node negative PTMC for clinicopathological features; such as the advanced tumor (T3, T4) including ETE, old age, male gender, multifocality although it may cause permanent morbidities such as hypoparathyroidism and recurrent laryngeal nerve injury, infrequently. [50,52,54,55] In conclusion, ETE of conventional PTMC is associated with tumor size, multifocality, and cervical lymph node metastasis.…”

“…[51][52][53] Prophylactic CLND may be performed in patients with clinically node negative PTMC for clinicopathological features; such as the advanced tumor (T3, T4) including ETE, old age, male gender, multifocality although it may cause permanent morbidities such as hypoparathyroidism and recurrent laryngeal nerve injury, infrequently. [50,52,54,55] In conclusion, ETE of conventional PTMC is associated with tumor size, multifocality, and cervical lymph node metastasis. Therefore, ETE of PTMC is an important factor in determining the extent of needed surgery; this is especially true with PTMC with fewer known prognostic factors.…”

Differentiated thyroid cancer—personalized therapies to prevent overtreatment

“…49 The extent of surgery required (for example, central and/or lateral lymph node dissection, gross extrathyroidal extension and the presence of one or more parathyroid glands in the pathology specimen) is associated with an increased risk of postoperative h ypoparathyroidism f ollowing thyroid cancer surgery. [50][51][52][53][54][55] Early postoperative monitoring of parathyroid hor mone (PTH) levels seems to be a sensitive method to quickly detect and prevent severe hypoparathyroidism. In a prospective study of 31 patients with PTH levels <10 pg/ml the morning after surgery, 50% of patients developed symptoms of hypocalcaemia, five of whom required intravenous calcium substitution.…”

Efficient detection of the V600E mutation of the BRAF gene in papillary thyroid carcinoma using multiplex allele-specific polymerase chain reaction combined with denaturing high-performance liquid chromatography

“…Furthermore, multivariate regression analysis also suggested that lymph node metastasis and the presence of BRAF V600E mutations were independent predictors for tumor prognosis, which is also in agreement with the literature (Costa et al, 2008;Henderson et al, 2009). As BRAF gene mutations and lymph node metastasis are closely associated with tumor recurrence, pre-operative detection of the mutation and conventional lymph node dissection may help to reduce the recurrence rate (Bozec et al, 2011;Alzahrani and Xing, 2013).…”