Factors affecting the adequacy of lymph node yield in prophylactic unilateral central neck dissection for papillary thyroid carcinoma

Lang, Brian Hung‐Hin; Yih, Patricia Chun-Ling; Shek, Tony W. H.; Wan, Koon Yat; Wong, Kai Pun; Lo, Chung‐Yau

doi:10.1002/jso.23201

Cited by 20 publications

(8 citation statements)

References 34 publications

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“…Thyroid cancer staging systems also indicate age as a prognostic factor [40]. A number of studies showed that PTC patients older than 45 years have poor prognosis [2,4,6,9,11,12]. However, several studies also indicated worse prognosis and the presenece of lymph node and distant metastasis in younger PTC patients.…”

Section: Discussionmentioning

confidence: 99%

“…The most common type of thyroid cancer is papillary thyroid cancer (PTC), representing 85% of all thyroid cancer cases [1]. According to the data from "Cancer Facts and Figures, 2016" , thyroid cancer was diagnosed in over 64,000 individuals in 2016 in the U.S.A, and the incidence rate increased approximately 5% in the last 10 years [2,3]. Although PTC is a slowly growing tumor and has an excellent prognosis, with expected 5-year survival greater than 98%, histological subtypes of PTC such as columnar cell variant (CCV), tall cell variant (TCV), and diffuse sclerosing variant (DSV) have a relatively worse prognosis [4,5].…”

Section: Introductionmentioning

confidence: 99%

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Relationship between lymphovascular invasion and clinicopathological features of papillary thyroid carcinoma

Sezer

Çelık

Bulbul

et al. 2017

Bosn J of Basic Med Sci

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Lymphovascular invasion (LVI) is an important prognostic factor in various solid tumors, however, data on the association between LVI and thyroid carcinomas are limited. In this study, we evaluated the relationship between LVI and clinicopathological features of papillary thyroid carcinoma (PTC). Six hundred seventy-eight patients diagnosed with PTC between 2012 and 2015 were included into the study. Patients were classified based on the presence or absence of LVI. Gender, age, ultrasonography (US), tumor size and multifocality, BRAFV600E mutation, perineural and capsular invasion, extrathyroid extension (ETE), nodal metastasis, and recurrences were evaluated, and risk analysis was performed for each parameter. The number of patients with LVI [LVI (+)] was 63, while the number of patients without LVI [LVI (-)] was 615. The female/male ratio was 564/114. LVI was present in 18.4% of male patients and in 7.4 % of female patients. In the age group between 17-25 years LVI was detected in 6/13 patients, and this result was statistically significant compared to other age groups (p = 0.004). Suspicious lymph nodes upon US, perineural or capsular invasion, ETE, tumor size, and nodal metastasis were significantly more frequent in LVI (+) group (p < 0.001). The frequency of BRAFV600E mutation was also significantly higher in LVI (+) group (p < 0.001). Overall, the presence of LVI was associated with gender, tumor size, age, lymph node metastasis, pathological lymph nodes, perineural and capsular invasion, ETE, and BRAFV600E mutation. These results suggest that in PTC patients undergoing thyroidectomy, the presence of LVI should be considered as an indicator of aggressive clinicopathological features and those patients should be followed up carefully for recurrences and metastasis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Relationship between lymphovascular invasion and clinicopathological features of papillary thyroid carcinoma

Sezer

Çelık

Bulbul

et al. 2017

Bosn J of Basic Med Sci

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“…However, it was interesting to note the incidence of central LNM varied widely from 23.5% to 82.4% between studies. Perhaps, this was also a reflection of the quality of preoperative USG assessment and might also have been a result of differences in the extent of the pCND and quality of the histological examination between studies (5,30,31). Also similar to previous meta-analyses,(9-11) we found the temporary hypocalcemia to be significantly higher in group A than B (26.0% vs. 10.8%, respectively; OR=2.56;95%CI=2.04 -3.21).…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review and Meta-Analysis of Prophylactic Central Neck Dissection on Short-Term Locoregional Recurrence in Papillary Thyroid Carcinoma After Total Thyroidectomy

Lang

Lau

et al. 2013

Thyroid

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Group A was more likely to have postoperative RAI ablation, temporary hypocalcemia, and overall morbidity than group B. Temporary hypocalcemia was the major surgical morbidity in pCND and, when excluded, the overall morbidity appeared similar between the two groups. Although our meta-analysis would suggest that those who undergo TT + pCND may have a 35% reduction in risk of LRR than those who undergo TT alone in the short term (< 5 years), it remains unclear how much of this risk reduction is related to increased use of RAI ablation and potential selection bias in some of the studies examined.

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“…A meta‐analysis of metastatic DTC in adults identified a mean (SD) lymph node yield of 41.0 (12.1) (range 27–66) 17 . Adequate unilateral lymph node yield from the central neck has been defined as six or more 18 . Results suggest that children and adults have a similar number of lymph nodes, that a similar number of lymph nodes can be resected during neck dissection, and that results from the present study are likely based on an adequate sample of nodal tissue.…”

Section: Discussionmentioning

confidence: 99%

Patterns and Predictors of Metastatic Spread to the Neck in Pediatric Thyroid Carcinoma

et al. 2020

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Objective Evaluate patterns and predictors of spread to the neck in pediatric metastatic differentiated thyroid carcinoma (DTC). Methods Patients <18 years old undergoing thyroidectomy by a single surgeon from January 2015 to December 2019 were included. Neck sublevels were removed separately according to AJCC boundaries. Clinical outcomes included nerve injury, hypocalcemia, hematoma, and residual tumor. Results Forty‐eight children underwent thyroid surgery. Thirty (63%) were for malignancy, 27 (90%) of which were DTC. Nineteen (70%) patients with DTC underwent 24 neck dissections; 19 central plus lateral and 5 central alone. The female to male ratio increased from 1:1 to 3:1 with age. Two children with lateral neck involvement had sub‐centimeter primaries. Patients requiring neck dissection were more likely to have 1) diffuse sclerosing or tall cell variant, 2) T3 or T4 disease, 3) genetic mutation, 4) lymphatic invasion, 5) extracapsular extension, 6) positive resection margin. Levels IIA (79%), III (89%), IV (84%), VI (100%) were most commonly involved. Levels IB (16%), IIB (16%), VB (16%) were also involved, often without involvement of adjacent levels. Permanent injuries included one unilateral recurrent laryngeal nerve, one mild marginal mandibular nerve and one mild accessory nerve. Hypocalcemia was highest following neck dissection for malignant disease. One patient was re‐operated for a mediastinal node. Most patients with N1 disease received radioactive iodine. Most patients have no evidence or indeterminate disease on long‐term follow‐up. Conclusion Children with lateral nodal spread from DTC should be considered for neck dissection including Levels IB, IIA, IIB, III, IV, VB, bilateral VI. Level of Evidence 4 Laryngoscope, 131:E1002–E1009, 2021

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Factors affecting the adequacy of lymph node yield in prophylactic unilateral central neck dissection for papillary thyroid carcinoma

Abstract: Length (or the longest measured dimension) of the fresh CLN specimen was the only factor assuring LNY ≥ 6. Surgical complications and short-term outcomes appeared similar between LNY <6 or ≥ 6.

Cited by 20 publications

References 34 publications

Relationship between lymphovascular invasion and clinicopathological features of papillary thyroid carcinoma

Relationship between lymphovascular invasion and clinicopathological features of papillary thyroid carcinoma

A Systematic Review and Meta-Analysis of Prophylactic Central Neck Dissection on Short-Term Locoregional Recurrence in Papillary Thyroid Carcinoma After Total Thyroidectomy

Patterns and Predictors of Metastatic Spread to the Neck in Pediatric Thyroid Carcinoma

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