Papillary carcinoma of the thyroid I. Developing pattern of metastasis

Abstract

Seventy‐one cases of papillary adenocarcinoma of the thyroid were operated on from January 1967 to July 1968. in 14 cases, the diagnosis of carcinoma was established postoperatively, so that 57 patients underwent systematic lymph node excision. Among these 57 cases, 90% had evidence of metastasis. a majority of metastatic deposits were small, i.e., 57% of them were less than 3 mm in diameter. There was no relationship between the location of primary tumor and metastasis; the initial metastases were most commonly observed in the pre‐ and paratracheal nodes, and subsequently, metastases were noted in the deep inferior and lateral cervical nodes. in patients who had a small number of metastatic deposits, the metastases were concentrated in the following sequence: pre‐ and paratracheal nodes, deep lower and lateral, and deep upper submandibular nodes. in those who had extensive metastases, the sequence of concentration was as follows: pre‐ and paratracheal, paraglandular and deep upper cervical, deep lower and lateral, and submandibular. From these observations, it can be concluded that metastasis of papillary thyroid carcinoma occurs first in paratracheal nodes, regardless of the location of the primary tumor. in the early stages, metastases are more frequent in the lower part of the neck. in later stages, when lymphatic obstruction has occurred, metastases appear in upper and submandibular nodes.

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

“…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).…”

Local and regional control in patients with papillary thyroid carcinoma: specific indications of external radiotherapy and radioactive iodine according to T and N categories in AJCC 6th edition

“…LN metastasis can appear in several levels and skip metastasis frequently occurs (Mirallie et al 1999). The correlation between the sites of LN metastasis and the tumor location within the thyroid is not consistent (Noguchi et al 1970). The rate of positive LN detection increases by immunohistochemical staining compared with H&E staining (Qubain et al 2002).…”

Regional Lymph Node Metastasis in Papillary Thyroid Cancer

“…Some authors have reported that each lobe of the thyroid gland has its own internal lymphatic system, and there is no communication with contralateral regional lymph nodes 14,15) (although PTC can spread to regional lymph nodes bilaterally [16][17][18] ) It has been generally accepted that lymphatic drainage occurs from the thyroid primarily to the central lymphatic compartment and secondarily to the lateral compartment nodes. 19,20) As a result, locoregional spread of thyroid cancer predominantly involves the ipsilateral, and sometimes also the contralateral central and lateral neck nodes. [21][22][23][24] Dralle and Machens 25) suggested that lymphatic tumor cell dissemination is modulated by the anatomical location of the primary thyroid tumor.…”