Pattern and Risk Factors of Central Compartment Lymph Node Metastasis in Papillary Thyroid Cancer: A Prospective Study from an Endocrine Surgery Centre

Agarwal, Shikha; Chand, Gyan; Jaiswal, Sushila; Mishra, Anjali; Agarwal, Gaurav; Agarwal, Amit; Verma, A.K.; Mishra, Saroj Kanta

doi:10.1155/2012/436243

Cited by 16 publications

(29 citation statements)

References 44 publications

(68 reference statements)

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“…However, some authors have argued its application in cN0 PTMC because of the high prevalence of CLNM 25,27,35,51. The removal of the occult nodes in the central compartment may confirm the status of the central lymph node for predicting LLNM and guiding treatment, with the aim of reducing the disease persistence 52–55. Although CLNM was not significantly associated with prognosis according to survival analysis, from the viewpoint of the radical treatment of tumors, prophylactic CLND must be considered in PTMC patients who present with high-risk factors.…”

Section: Discussionmentioning

confidence: 99%

Risk prediction and clinical model building for lymph node metastasis in papillary thyroid microcarcinoma

Lin¹,

Qu²,

Shi³

et al. 2016

OTT

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The surgical management of papillary thyroid microcarcinoma (PTMC), especially regarding the necessity of central/lateral lymph node dissection, remains controversial. This study investigated the clinicopathologic factors predictive of lymph node metastasis (LNM) in patients diagnosed with PTMC. Multivariate logistic regression analysis was used for PTMC patients identified from the Surveillance, Epidemiology, and End Results database who were treated by surgery between 2002 and 2012, to determine the association of clinicopathologic factors with LNM. According to the results, a total of 31,017 patients met the inclusion criteria of the study. Final histology confirmed 2,135 (6.9%) cases of N1a disease and 1,684 cases (5.4%) of N1b disease. Our multivariate logistic regression analysis identified variables associated with both central LNM and lateral lymph node metastasis (LLNM), including a younger age (<45 years), male sex, non-Hispanic white and other race, classical papillary histology, larger tumor size, multifocality, and extrathyroidal extension; distant metastasis was also significantly associated with LLNM. The significant predictors identified from multivariable logistic regression were integrated into a statistical model that showed that extrathyroidal extension had maximum weight in the predictive role for LNM. LLNM was validated to be a significant risk factor for cancer-specific death in Cox regression analyses, whereas central LNM failed to predict a worse cancer-specific survival according to our data. Therefore, we suggested that central lymph node dissection could be performed in certain patients with risk factors. Given the prevalence of LLNM in PTMC, a thorough inspection of the lateral compartment is recommended in PTMC patients with risk factors for precise staging; from the viewpoint of a radical treatment for tumors, prophylactic lateral lymph node dissection that aims to remove the occult lateral lymph nodes may be an option for PTMC with risk factors. Multicenter studies with long-term follow-up are recommended to better understand the risk factors and surgical management for cervical nodes in PTMC.

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Section: Discussionmentioning

confidence: 99%

Risk prediction and clinical model building for lymph node metastasis in papillary thyroid microcarcinoma

Lin¹,

Qu²,

Shi³

et al. 2016

OTT

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“…Cervical LNM was common in PTC patients and accounts for 30%-80% [4,5,21], LNM was associated with local recurrence PTC and overall mortality of patients [6,7]. Reoperation for PTC recurrence may increase the operative complication and have a negative effect on patient's quality of life.…”

Section: Discussionmentioning

confidence: 99%

“…In China, PTC is the most common malignant tumor in women under 30 years old, its incidence rate ranks 8th in women [2,3]. PTC often disseminates into cervical lymph nodes with a reported incidence from 30% to 80 % at the first diagnosis [4,5], cervical lymph nodes metastasis (LNM) is an important factor affecting local recurrence of PTC and long-term survival of patients [6,7].…”

Section: Introductionmentioning

confidence: 99%

A nomogram to predict skip metastasis in papillary thyroid cancer

Ouyang

Wang²

2020

Preprint

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Background Skip metastases are defined as lateral lymph node metastasis (LNM) without the involvement of central LNM in papillary thyroid cancer (PTC), and it is difficult to predict in clinical practice. Our study aimed to investigate the risk factors of skip metastasis and establish a nomogram for predicting the probability of skip metastasis in PTC patients. Patients and Methods A total of 378 consecutive PTC patients with clinically suspected LNM who underwent modified radical neck dissection (MRND) from March 2018 to July 2019 were enrolled in our hospital, Univariate and multivariate analyses were used to examine risk factors of skip metastasis, and a nomogram prediction model was established and internal validated. Results The incidence of skip metastasis was 11.9% (45/378). Primary tumor size ≦1cm(OR=2.703, 95%CI,1342-5.464; P =0.005 ), Age(OR=1.051, 95%CI, 1.017-1.805, P =0.005), Primary tumor location in the upper portion(OR=6.799, 95%CI, 2.710-17.060, P < 0.001)were found to be independent risk factors for skip metastasis in PTC patients. A nomogram based upon these predictors performed well. With an area under the curve (AUC) of 0.806 (95%CI,0.736-0.876) and the P value of the Hosmer-Lemeshow goodness of fit test was 0.66, Decision curve analysis revealed that nomogram was clinically useful. Conclusion Based on the risk factors of skip metastasis and established a high-performance nomogram, which can provide an individual risk assessment and guide treatment decisions for patients.

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“…Unlike follicular carcinoma, it has predilection for lymphatic spread; the sequence of spread being first to the central compartment (VI), then to the ipsilateral lateral compartments (II, III and IV), and later to the ipsilateral posterior triangle compartment (V), skip lesions however are encountered rarely. 7,8 The presence of cervical lymph node metastasis is a known predictor of loco-regional recurrence and therapeutic central lymph node dissection reduces the frequency of this loco-regional recurrences. 7,9 This relation of lymph node metastasis to locoregional recurrence has now shifted the standard Professional Med J 2017;24(7):1084-1087.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 The presence of cervical lymph node metastasis is a known predictor of loco-regional recurrence and therapeutic central lymph node dissection reduces the frequency of this loco-regional recurrences. 7,9 This relation of lymph node metastasis to locoregional recurrence has now shifted the standard Professional Med J 2017;24(7):1084-1087.…”

Section: Discussionmentioning

confidence: 99%