Clinicopathological predictors of occult lateral neck lymph node metastasis in papillary thyroid cancer: A meta‐analysis

Zhan, Shaohua; Luo, Di; Ge, Wei; Zhang, Bin; Wang, Tianxiao

doi:10.1002/hed.25762

Cited by 37 publications

(20 citation statements)

References 40 publications

(68 reference statements)

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“…Kim ( 22 ) found that the overall frequencies of central and lateral LNMs in PTMC were 39.6% and 3.0%, respectively. A meta-analysis of 5,342 PTC cases showed that ( 23 ) the frequency of occult lateral neck lymph node metastases was 47.8%. A majority of studies have shown that cervical LNM, especially lateral LNM, carries prognostic significance ( 21 , 24 – 26 ).…”

Section: Discussionmentioning

confidence: 99%

Lateral Lymph Node Metastases in T1a Papillary Thyroid Carcinoma: Stratification by Tumor Location and Size

et al. 2021

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ObjectiveTo analyze the incidence and risk factors for lateral lymph node metastases (LNMs) in T1a papillary thyroid carcinoma (PTC) with a focus on tumor location and size.Materials and MethodsThe incidence of lateral LNM in 345 cases of T1a PTC was retrospectively analyzed. Univariate and multivariate analyses were performed to assess the relationships between lateral LNM and clinicopathological characteristics.ResultsThe incidence of skip metastasis to lateral LNM in T1a PTC located in the upper lobe was 12.1% (8/66). Logistic regression analysis indicated tumor size >5 mm (OR = 5.04, 95% CI = 1.79 to 14.18, P = 0.002), upper lobe location (OR = 7.68, 95% CI = 3.05–19.34, P < 0.001) and the number of central neck LNM (<2: OR = 24.79, 95% CI = 8.23–74.60, P < 0.001; ≥2: OR = 4.99, 95% CI = 1.95–12.73, P < 0.001) were independently associated with lateral LNM. Comparing the lateral and central LNM stratification based on tumor location revealed that both the incidences of lateral (33.3%) and central (30.3%) LNM of T1a PTC located in the upper lobe were higher than those of T1a PTC located in the middle and lower lobes. Of T1a PTC located in the upper lobe, the incidence of lateral LNM was 33.3% (22/66), which was higher than that [30.3% (20/66)] of central LNM. This finding is reversed in all T1a PTC cases and T1a PTC cases with tumor located in the middle and lower lobes.ConclusionA particularly high likelihood of lateral LNM was observed in T1a PTC patients with tumor located in the upper lobe of the thyroid gland, especially the tumor >5 mm in size, which could be considered a risk factor for lateral LNM in the clinical management of T1a PTC.

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Section: Discussionmentioning

confidence: 99%

Lateral Lymph Node Metastases in T1a Papillary Thyroid Carcinoma: Stratification by Tumor Location and Size

et al. 2021

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“…In view of this result, we suggest that central lymph node dissection for male patients should be thoroughly and carefully evaluated by the surgeon during surgery. Male gender is considered positively associated with LLNM in some studies [11,29], while such a relationship is not observed in many other reports [30,31]. We also investigated the correlation between gender and LLNM.…”

Section: Discussionmentioning

confidence: 88%

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

Zhu

Huang

Yü

et al. 2022

International Journal of Endocrinology

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Background. The incidence of papillary thyroid carcinoma (PTC) is higher in females than in males, but it remains unclear whether gender is associated with the aggressiveness of this disease. We aimed to clarify the influence of gender on the risk of developing lymph node metastasis (LNM) and on the prognosis of PTC patients. Study Design. Retrospective cohort study. Setting. Academic tertiary care center. Methods. Clinical data of PTC patients who were admitted to the Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, between January 2013 and December 2018 were retrospectively reviewed. The differences in clinical features and outcomes between female and male patients were compared. Univariate and multivariate logistic regression analyses were conducted to assess the impact of gender on LNM. Kaplan–Meier curves were used to estimate recurrence-free survival (RFS). Results. A total of consecutive 2536 patients were enrolled in this study. Males accounted for 25.2% (639 cases) of all patients. Central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM) rates were 52.5% (1346/2536) and 22.0% (558/2536), respectively. Male presented with higher LNM rates than female patients (65.7% vs. 51.2%; P < 0.001 ). Male gender was independently associated with LNM (OR = 1.93, 95% CI: 1.59–2.35; P < 0.001 ). After full adjustment, male gender still remained significantly associated with CLNM in all subgroups; however, subgroup analyses indicated no significant relationship between gender and LLNM. In addition, after a median follow-up period of 30 months, no significant difference was found in RFS between female and male patients ( P = 0.15 ). Conclusions. This observational cohort study revealed that male gender was significantly associated with CLNM; whereas, LLNM was not different between female and male PTC patients in southwestern China. Moreover, currently, there is insufficient evidence to justify that male gender is an independent prognostic factor for recurrence.

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“…In patients with unilateral N1b PTC, contralateral lateral LN involvement could be found in about one‐third of patients, despite the preoperative US being negative 30 . The incidence of occult lateral neck LNM was 47.8% in patients with N0/N1a stage PTC in a meta‐analysis, 31 indicating that the conventional imaging methods cannot accurately detect the metastatic LNs. However, it is unclear whether these microscopic metastases would progress to clinically significant disease if they are not included in the dissection.…”

Section: Discussionmentioning

confidence: 99%

Lateral neck multilevel fine‐needle aspiration cytology and thyroglobulin estimation in papillary thyroid carcinoma

Song

Wang

et al. 2021

Laryngoscope Investig Oto

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Objective To assess the accuracy of preoperative ultrasound‐guided multilevel fine‐needle aspiration (FNA) cytology and thyroglobulin (Tg) estimation in mapping metastatic levels in the lateral neck, in patients with papillary thyroid carcinoma (PTC). Methods Patients with PTC clinically metastasizing to the lateral neck who were initially treated at the Peking University Cancer Hospital from June 2018 to September 2020 were included. FNA was performed preoperatively in each suspicious neck level; cytological examination (FNA‐C) and Tg measurement of the needle‐washout fluid (FNA‐Tg) were combined to determine metastasis. FNA‐Tg cutoff value was calculated, and the accuracy of FNA at different levels were evaluated. Results In total, 111 patients underwent 124 lymph node dissections. The best cutoff value of FNA‐Tg for the diagnosis of metastatic level was 1.0 ng/mL. Multilevel FNA showed sensitivity, specificity, positive predictive value, and negative predictive value in predicting single‐level metastasis of 100%, 61.0%, 43.9%, and 100%, respectively. In 64 (51.6%) cases, the involved levels diagnosed by FNA were consistent with that diagnosed by postoperative pathology. Conclusion FNA‐Tg improves the diagnostic performance of FNA‐C in lateral neck lymph node metastases. However, limited accuracy was obtained for preoperative multilevel FNA in predicting the extent of metastasis in the lateral compartment.

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Clinicopathological predictors of occult lateral neck lymph node metastasis in papillary thyroid cancer: A meta‐analysis

Cited by 37 publications

References 40 publications

Lateral Lymph Node Metastases in T1a Papillary Thyroid Carcinoma: Stratification by Tumor Location and Size

Lateral Lymph Node Metastases in T1a Papillary Thyroid Carcinoma: Stratification by Tumor Location and Size

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

Lateral neck multilevel fine‐needle aspiration cytology and thyroglobulin estimation in papillary thyroid carcinoma

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