Patterns of Occult Metastasis to Level Va and Vb in Clinically Lateral Node-Positive Papillary Thyroid Carcinoma

Song, Kyung‐Sik; Jin, Yanli; Kim, Mingyu; Moon, Seoksu; Heo, Da Beom; Won, Ho-Ryun; Chang, Jae Won; Koo, Bon Seok

doi:10.1245/s10434-021-11085-9

Cited by 5 publications

(5 citation statements)

References 30 publications

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“…Yang et al object to routine V-region lymph node dissection in patients with N1bPTMC citing a relatively low incidence of V-level metastasis and recurrence. [21][22][23] Although the cited incidence is consistent with the results obtained in this study, the risk of global local recurrence rate is significantly increased when there are 3 levels of metastasis present where 1 includes level V metastasis. Thus, when metastasis transpires at level V, even if metastasis is only detected in 1 or 2 levels, it leads to a negative impact on the local recurrence rate.…”

Section: Discussionsupporting

confidence: 90%

Lateral lymph node metastasis in papillary thyroid cancer: Is there a difference between PTC and PTMC?

Ma,

Guo,

Hua

et al. 2024

Medicine

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Papillary thyroid carcinoma (PTC) and papillary thyroid microcarcinoma (PTMC) are generally characterized as less invasive forms of thyroid cancer with favorable prognosis. However, once lateral cervical lymph node metastasis takes place, the prognosis may be significantly impacted. The purpose of this study was to evaluate whether there is a difference in the pattern of lateral lymph node metastasis between PTC and PTMC. A retrospective analysis was performed for PTC and PTMC patients that underwent central area dissection and unilateral lateral neck lymph node dissection (II–V area) between January 2020 and December 2021. Compared with PTMC group, the PTC group exhibited higher incidence of capsule invasion, extrathyroid invasion and lymphatic vessel invasion. Both the number and rate of central lymph nodes metastasis were elevated in the PTC group. While the number of lateral cervical lymph node metastasis was higher, the metastasis rate did not demonstrate significant difference. No significant differences were identified in the lymph node metastasis patterns between the 2 groups. The determination of the extent of lateral neck lymph node dissection solely based on the tumor size may be unreliable, as PTC and PTMC showed no difference in the number and pattern of lateral neck metastasis. Additional clinical data are warranted to reinforce this conclusion. For patients categorized as unilateral, bilateral, or contralateral cervical lymph node metastasis (including level I, II, III, IV, or V) or retropharyngeal lymph node metastasis who require unilateral lateral neck dissection, the size of the primary tumor may not need to be a central consideration when assessing and deciding the extent of lateral neck dissection.

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Section: Discussionsupporting

confidence: 90%

Lateral lymph node metastasis in papillary thyroid cancer: Is there a difference between PTC and PTMC?

Ma,

Guo,

Hua

et al. 2024

Medicine

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“…Unless suspicious LLNM is confirmed by preoperative fine needle aspiration cytology (FNAC), prophylactic lateral neck dissection (LND) is not recommended for patients with clinically negative (cN0) lateral neck ( 1 ). However, the incidence of occult LLNM was reported to be as high as 30.4% among PTC patients ( 8 ). Considering the presence of occult LLNM, which was hardly detected in the preoperative period, some patients who undergo thyroidectomy may detect the residual metastatic lymph nodes in the lateral compartment ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

Nomograms for the prediction of lateral lymph node metastasis in papillary thyroid carcinoma: Stratification by size

Feng

Ye²,

Hong³

et al. 2022

Front. Oncol.

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BackgroundLateral lymph node metastasis (LLNM) is a risk factor of poor prognosis in papillary thyroid cancer (PTC). We aimed to determine predictive factors and develop the nomograms for LLNM in patients with papillary thyroid microcarcinoma (PTMC) and macro-PTC.MethodsWe reviewed the medical records of 1,106 patients who underwent surgery between January 2019 and January 2022. Patients were divided into a PTMC and a macro-PTC group. We developed preoperative and postoperative nomograms for predicting LLNM based on results of multivariate analysis. Internal calibration was performed for these models.ResultsThe number of metastatic lymph nodes in lateral compartment was higher in macro-PTC patients. LLNM was independently associated with gender, the number of foci, location, shape, and central lymph node metastasis (CLNM) in PTMC patients. For macro-PTC patients, chronic lymphocytic thyroiditis, the number of foci, location, margin, CLNM, and central lymph node ratio were all independent predictors for LLNM. All the above factors were incorporated into nomograms, which showed the perfect discriminative ability.ConclusionThe diameter of the tumor has an impact on the rate of LLNM. Separate predictive systems should be used for PTMC and macro-PTC patients for more accurate clinical assessment of lateral lymph node status. Through these nomograms, we can not only detect high-risk patients with occult LLNM preoperatively, but also form appropriate treatment protocols for postoperative management of PTC patients with different risks.

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“…Bhattacharyya reviewed the data of 2,097 patients with papillary thyroid carcinoma and found no statistically significant difference in recurrence or death rates between patients who underwent SND and MRND for nodal metastasis (18). Therefore, several studies have argued against routine level V dissection in patients with N1b PTMC because of the relatively low incidence of level V metastasis and recurrence (19)(20)(21). However, level V metastasis, if found simultaneously with 1-or 2-level metastasis, may have a negative impact on locoregional recurrence rate (6).…”

Section: Discussionmentioning

confidence: 99%

The optimal extent of lymph node dissection in N1b papillary thyroid microcarcinoma based on clinicopathological factors and preoperative ultrasonography

Liu¹,

Duan²,

Yang³

et al. 2022

Gland Surg

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Patterns of Occult Metastasis to Level Va and Vb in Clinically Lateral Node-Positive Papillary Thyroid Carcinoma

Cited by 5 publications

References 30 publications

Lateral lymph node metastasis in papillary thyroid cancer: Is there a difference between PTC and PTMC?

Lateral lymph node metastasis in papillary thyroid cancer: Is there a difference between PTC and PTMC?

Nomograms for the prediction of lateral lymph node metastasis in papillary thyroid carcinoma: Stratification by size

The optimal extent of lymph node dissection in N1b papillary thyroid microcarcinoma based on clinicopathological factors and preoperative ultrasonography

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