Clinical implications of Delphian lymph node metastasis in papillary thyroid carcinoma

Abstract

Background: As is known, identifying risk factors precisely for lymph node metastasis (LNM) plays a vital role in initial treatment for papillary thyroid carcinoma (PTC). Nonetheless, whether Delphian lymph node (DLN) metastasis has value in predicting LNM remains an open question. This study covered a sample of 1,575 patients, which is the largest sample group so far, aiming to assess the predictive validity of DLN metastasis in PTC. Methods: This retrospective cohort study was conducted with 1,575 eligible PTC patients who underwent thyroid operation between July 2013 and December 2018 and clinicopathologic parameters of patients with DLN metastasis were compared with those without DLN metastasis. Results: The incidence of DLN metastasis, according to our research samples, is 24.4% (384/1,575 patients). And results show that DLN positivity was closely associated with adverse prognostic factors including younger age, larger tumor size, extrathyroid extension, tumor location in the isthmus or upper lobe of the thyroid, number of LNM >5, higher recurrence. After carefully adjusting important confounding factors, we find that in multivariate logistic regression analyses, DLN metastasis is an independent predictor for both central LNM (CLNM, adjusted OR =7.81, P<0.001) and lateral LNM (LLNM, adjusted OR =3.40, P<0.001). Moreover, the stratified analyses also show convincing evidence of a positive correlation between DLN metastasis and LNM in levels II-IV in the vast majority of subgroups.Conclusions: The present study suggests that DLN metastasis is an independent risk factor for CLNM and LLNM of levels II-IV. The cervical lymph nodes should be meticulously evaluated to guide tailored treatment during operation in patients with DLN involvement.

Application of Machine Learning Algorithms to Predict Central Lymph Node Metastasis in T1-T2, Non-invasive, and Clinically Node Negative Papillary Thyroid Carcinoma

“…At our institution, lymph nodes in central compartment are classified as DLN, pretracheal and paratracheal nodes, respectively, and then routinely sent for frozen section examination separately. It was revealed in our previous study that the status of DLN based on frozen section examination was an independent predictor of CLNM and associated with poor prognostic features (14). And our findings of the present study further proves it, showing that 86.3% of DLN-positive patients have CLMN, compared with 43.9% of DLN-negative patients.…”

“…At our institution, it is customary to perform pCLND for PTC patients and the detailed surgical procedures were described in previous articles (13,14). Soft tissues in the prelaryngeal and pretracheal regions were removed and marked as the Delphian (Figure 1) and pretracheal LNs, respectively.…”

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

“…Compelling evidence demonstrates that the majority of anterior laryngeal lymph node drainage originates from the superior thyroid lobe, the isthmus, and the conus of the thyroid. As such, anterior laryngeal lymph node metastasis is hypothesized to have a close association with the lesion location, especially in the isthmus and upper third of the thyroid gland ( 15 , 18 , 20 ). For instance, Chai et al.…”

Male Gender Is Associated with Lymph Node Metastasis but Not with Recurrence in Papillary Thyroid Carcinoma

“…As described previously, our PTC patients underwent standard treatment procedures: lobectomy plus ipsilateral central compartment lymph node dissection which is recommended by Chinese guideline [22][23][24]. In our center, intraoperative frozen section of ipsilateral central lymph nodes was routinely used.…”