Perineural Invasion in Papillary Thyroid Cancer: A Rare Indicator of Aggressive Disease

Limberg, Jessica; Lee-Saxton, Yeon J; Egan, Caitlin E.; Alanazi, Alanoud; Easthausen, Imaani; Stefanova, Dessislava; Stamatiou, Alexia T.; Beninato, Toni; Zarnegar, Rasa; Scognamiglio, Theresa; Fahey, Thomas J.; Finnerty, Brendan M.

doi:10.1245/s10434-023-13307-8

Cited by 4 publications

(4 citation statements)

References 23 publications

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“…Sezer et al [81] reported a 10 times higher PNI rate among patients with LVI. In comparison, in this study, the rate of PNI was found to be 1.8% (13 of 706 patients), in line with the findings of previous studies [80,81]. Univariate analysis revealed the presence of PNI as a significant risk factor for LNM and recurrence.…”

Section: Discussionsupporting

confidence: 92%

“…In conclusion, the use of TTD, which includes quantitative data on tumor volume, particularly the TTD cutoff value of > 10 mm, as a prognostic marker may represent a more accurate approach in the clinical management of multifocal PTCs, especially PTMCs. Perineural invasion, which may present in a clinically aggressive manner in many carcinomas, including breast and pancreatic carcinomas, involves a distinct metastatic pathway [79,80]. Although PNI is very rare in PTCs (1.5-1.8%) [80,81], some recent studies reported that increased nerve density and perineural invasion may be predictors of poor prognosis in terms of LVI, ETE, LNM, and extranodal extension (ENE) in PTCs [79][80][81].…”

Section: Discussionmentioning

confidence: 99%

“…Perineural invasion, which may present in a clinically aggressive manner in many carcinomas, including breast and pancreatic carcinomas, involves a distinct metastatic pathway [79,80]. Although PNI is very rare in PTCs (1.5-1.8%) [80,81], some recent studies reported that increased nerve density and perineural invasion may be predictors of poor prognosis in terms of LVI, ETE, LNM, and extranodal extension (ENE) in PTCs [79][80][81]. Limberg et al [80] reported higher rates of ENE in intrathyroidal tumors with PNI than those without PNI.…”

Section: Discussionmentioning

confidence: 99%

“…Although PNI is very rare in PTCs (1.5-1.8%) [80,81], some recent studies reported that increased nerve density and perineural invasion may be predictors of poor prognosis in terms of LVI, ETE, LNM, and extranodal extension (ENE) in PTCs [79][80][81]. Limberg et al [80] reported higher rates of ENE in intrathyroidal tumors with PNI than those without PNI. Rowe et al [79] reported a significant relationship between increased nerve density and ETE in PTCs.…”

Section: Discussionmentioning

confidence: 99%

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The Impact of Total Tumor Diameter on Lymph Node Metastasis and Tumor Recurrence in Papillary Thyroid Carcinomas

Can,

Bulbul,

Ozyilmaz

et al. 2024

Diagnostics

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(1) Introduction: The impact of multifocality/bilaterality on the prognosis of papillary thyroid carcinoma (PTC) is a matter of debate. In order to clarify this debate, several studies have attempted to identify additional parameters associated with poor prognosis, including total tumor diameter (TTD), in the context of multifocal PTCs. In this context, this study was carried out to investigate the impact of TTD on tumor recurrence and lymph node metastasis (LNM) in PTCs. (2) Materials and Methods: The sample of this single-center retrospective study consisted of 706 patients diagnosed with PTC. TTD was calculated as the sum of the largest diameters of tumor foci in multifocal tumors. The resulting TTDs were grouped into TTDs ≤ 10 mm, TTDs > 10 mm, TTDs ≤ 20 mm, and TTDs > 20 mm, using 10 mm and 20 mm as cutoff values. (3) Results: There was no significant difference between multifocal papillary microcarcinomas (PTMCs) with a TTD of >10 mm and unifocal PTCs with a primary tumor diameter (PTD) of >10 mm except for advanced age and lymphovascular invasion (LVI). In addition, perineural invasion (PNI) and TTD > 10 mm were found to be significant risk factors for LNM, and PNI, TTD > 10 mm, TTD > 20 mm, and bilaterality were found to be significant risk factors for recurrence. LVI, and TTD > 10 mm were found to be independent significant predictors for recurrence, and LVI and extrathyroidal extension (ETE) were found to be independent significant predictors for LNM. (4) Conclusions: Considering TTD > 10 mm in recurrence risk categorization models and adopting a clinical approach that takes into account multifocal PTMCs with TTD > 10 mm along with unifocal PTCs with PTD > 10 mm may be more useful in terms of clinical management of the disease.

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Section: Discussionsupporting

confidence: 92%