Elective neck dissection in papillary carcinoma of the thyroid

Attie, Joseph N.; Khafif, Rene A.; Steckler, Robert M.

doi:10.1016/0002-9610(71)90469-7

Cited by 107 publications

(46 citation statements)

References 14 publications

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“…As in previous studies, papillary thyroid carcinoma had been known to be more commonly found with cervical lymph node metastases than follicular carcinoma (Coburn & Wanebo 1992, Sellers et al 1992). From 63 to 80% of papillary thyroid carcinoma patients had micrometastases (Noguchi et al 1970, Attie et al 1972. Most of these micrometastases were clinically insignificant (Sellers et al 1992).…”

Section: Discussionmentioning

confidence: 58%

“…In contrast, Coburn & Wanebo (1992) demonstrated that limited lymph node metastases were not significant prognostic variables. In prophylactic neck dissections, 27-82% of well-differentiated thyroid carcinoma patients had occult nodal metastases (Attie et al 1972, Noguchi & Murakami 1987, Simpson et al 1987. At present, neck dissections are recommended only for patients with palpable lymphadenopathy of well-differentiated thyroid carcinomas (Sellers et al 1992).…”

Section: Introductionmentioning

confidence: 99%

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Prognostic variables of papillary and follicular thyroid carcinoma patients with lymph node metastases and without distant metastases.

Lin

Liou²,

Chao³

et al. 1999

Endocrine-Related Cancer

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From 1977 through 1995, 1013 thyroid carcinoma patients received treatment and were followed up at Chang Gung Medical Center in Taiwan. To evaluate the prognostic variables of papillary and follicular thyroid carcinomas with limited lymph node metastases, a retrospective review of these patients was performed. Of these patients, 910 had papillary or follicular thyroid carcinoma, and 119 patients were categorized as clinical stage 2 with limited neck lymph node metastases only at the time of diagnosis. The patients were categorized into two groups as no recurrence and local recurrence or distant metastasis at the end of 1997. After the operations, radioactive iodide ( 131 I) treatments were performed in 114 patients and external radiotherapy for neck region or distant metastases in 18 patients. The median follow-up period of these patients was 5.4 years. Clinical variables were coded in our computer for statistical analysis. After the treatments, 93 patients remained disease-free; 10 were in stage 2; 5 in stage 3; and 11 aggravated to stage 4. Of the clinical variables, age, postoperative first 131 I uptake scans, and 1-month post-operative thyroglobulin levels revealed statistically significant differences between the group which improved and the group which did not. During the follow-up period, five patients died; three patients died of thyroid cancer and two died of intercurrent diseases. Patients with papillary thyroid carcinoma revealed a higher percentage of lymph node metastases. Although limited lymph node metastases did not influence survival rate, patients with poor Endocrine-Related Cancer (1999) 6 109-115 prognostic factors need more aggressive treatment to avoid progression of the cancer. Lin et al.: Thyroid carcinoma with lymph node metastases 110influence of limited lymph node metastases of welldifferentiated thyroid carcinoma at the time of diagnosis and the prognostic variables of patients, 1013 thyroid cancer patients were retrospectively reviewed at our medical center. Subjects and methodsFrom January 1977 through December 1995, 1013 thyroid carcinoma patients received primary treatment and were followed-up at Chang Gung Medical Center in Linkou, Taiwan. Of these patients, 910 had papillary or follicular thyroid carcinomas. Either near total thyroidectomy or modified radical neck thyroidectomy was performed on 689 patients after the tumors were found to be malignant by preoperative fine-needle aspiration or frozen sections. Two hundred and ten patients received either subtotal thyroidectomy or lobectomy only. Most of these patients received limited lymph node dissection in the anterior compartment of the neck only unless there were clinically detectable lymph node enlargements. One patient received biopsy only. Ten patients were referred from other hospitals without detailed records of the surgical methods used.Four to six weeks after the operations, whole body 131 I image scans were performed after using 5 mCi 131 I for diagnostic scans. When 5 mCi 131 I scan was used for diagnos...

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Section: Discussionmentioning

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Prognostic variables of papillary and follicular thyroid carcinoma patients with lymph node metastases and without distant metastases.

Lin

Liou²,

Chao³

et al. 1999

Endocrine-Related Cancer

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“…It is considered to be a relatively indolent malignancy in which distant metastasis and death from disease are uncommon (Mazzaferri 1981). PTC, including papillary microcarcinoma (%1 cm), frequently presents as a multifocal process (Noguchi et al 1970, Attie et al 1971. Multifocality in papillary microcarcinoma is reported in 20-47% of cases and up to 40% of these patients can present with lymph node metastases (David et al 1992, Rodriguez et al 1997, Baudin et al 1998, Arem et al 1999.…”

Section: Introductionmentioning

confidence: 99%

Molecular analysis of multifocal papillary thyroid carcinoma

Lin¹,

Finkelstein²,

Zhu³

et al. 2008

Journal of Molecular Endocrinology

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Papillary thyroid carcinoma (PTC) frequently presents as a multifocal process. To study the importance of separating independent primary (IP) from intrathyroid metastatic (ITM) PTC, we examined 19 molecular markers on 42 separate tumors from 18 multifocal PTC cases. In 12 of 18 (66 . 7%) cases, including 6 of 12 (50%) papillary microcarcinoma cases, the same or similar profile of loss of heterozygosities (LOH) and v-raf murine sarcoma viral oncogene homolog B1 (BRAF) mutation was demonstrated, indicating that they were from the same primary and represented ITM. Different profiles of LOHs and BRAF mutation were detected in separate tumors of 6 of 18 cases, indicating that they represented IP. Patients with ITM, including papillary microcarcinoma, had significantly increased lymph node metastasis. The frequencies of LOHs of 17q21, 17p13, 10q23, and 22q13 were higher in tumors with lymph node metastasis, suggesting that these LOHs may be important in increased lymph node metastasis. LOH of 9p21 was found at the highest frequency in PTC (53 . 8%), followed by 1p36 (46 . 2%), 10q23 (34 . 6%), and 22q13 (34 . 6%). Papillary microcarcinoma had acquired similar genomic mutations as conventional PTC, but higher frequencies of mutations of BRAF, 1p36, 18q, and 22q13 were found in the larger PTC, suggesting that they might play a role in the aggressiveness of PTC. Different profiles of mutations were observed in conventional, follicular variants, and diffuse sclerosing variant of PTC, which might influence the different morphological appearances and clinical courses. In conclusion, molecular analysis can separate multifocal IP PTC from ITM PTC, and may be more important than tumor size in predicting lymph node metastasis, aggressiveness, and prognosis of PTC.

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“…In fact, when prophylactic lymphadenectomy was performed on all patients with PTC in the early years of surgical management, up to 90% were found to have microscopic lymph node metastases Attie et al 1971;Frazell and Foote 1955). The presence of micrometastases in the cervical lymph nodes, however, has not been shown to affect survival (Young et al 1980;Hay et al 1993;Byar et al 1979;Grebe and Hay 1996).…”

Section: Management Of Lymph Node Diseasementioning

confidence: 99%

Multi-targeted approach in the treatment of thyroid cancer

Zarebczan

Chen

2008

TCRM

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While accounting for only 1% of solid organ malignancies (9% in women), thyroid carcinoma is the most common malignancy of the endocrine system. Although most patients have a favorable prognosis, over 1,500 people will die from thyroid carcinoma each year. The spectrum of disease types range from papillary thyroid cancer, which is a well-differentiated indolent tumor, to anaplastic carcinoma, a poorly differentiated fulminant cancer. With advances in diagnostic methods, surgical techniques, and clinical care of patients with thyroid carcinoma, the current management of thyroid cancer demands a multidisciplinary approach. The majority of patients with well-differentiated thyroid carcinoma of follicular cell origin are cured with adequate surgical management; however, some thyroid malignancies such as medullary thyroid carcinoma (MTC) or poorly differentiated thyroid carcinomas frequently metastasize, precluding patients from a curative resection. As such, novel palliative and therapeutic strategies are needed for this patient population. Here, we explore the current management of thyroid carcinoma, including surgical management of the primary tumor, lymph node disease, and locoregional recurrence. Likewise, we explore the application of current molecular techniques, reviewing nearly two decades of data that have begun to elucidate critical genetic pathways and therapeutic drug targets which may be important in specifi c thyroid tumor types.

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Elective neck dissection in papillary carcinoma of the thyroid

Cited by 107 publications

References 14 publications

Prognostic variables of papillary and follicular thyroid carcinoma patients with lymph node metastases and without distant metastases.

Prognostic variables of papillary and follicular thyroid carcinoma patients with lymph node metastases and without distant metastases.

Molecular analysis of multifocal papillary thyroid carcinoma

Multi-targeted approach in the treatment of thyroid cancer

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