Prediction of central lymph node metastasis in 392 patients with cervical lymph node-negative papillary thyroid carcinoma in Eastern China

Xiang, Yingying; Lin, Kan; Dong, Siyang; Qiao, L I; He, Qiu-Xiang; Zhang, Xiaohua

doi:10.3892/ol.2015.3544

Cited by 17 publications

(22 citation statements)

References 34 publications

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“…17 Emerging evidences have demonstrated decreased disease-free survival rate and increased mortality associated with regional LNM. 18 Even though lots of novel methods were emerging to target cancer cells and LNM of PTC, 19 LND is generally recommended in PTC patients with LNM. However, the extensive postoperative complications caused by LND should not be ignored which will reduce the quality of life of patients.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Level V Lymph Node Metastases in Papillary Thyroid Carcinoma with BRAFV600E Mutation and Clinicopathological Features

Li¹,

Tan²,

Chen³

et al. 2020

CMAR

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Background: Therapeutic lateral neck dissection (LND) is recommended in papillary thyroid carcinoma (PTC) patients with clinically lateral lymph node metastasis (LLNM), whether underwent level V LND remains controversial for lacking of sensitive predicting system. BRAF V600E mutation is associated with aggressive tumor behavior, recurrence, and disease-specific mortality of PTC. However, the relationship between BRAF V600E mutation and level V LNM is unclear. Methods: Univariate and multivariate analyses were retrospectively conducted on the potential predictive factors of 252 PTC patients who underwent initial treatment of neck lymph node dissection from September 2015 to October 2018 in our institute. BRAF V600E mutation and the clinicopathological characteristics of the two groups were compared. Results: LLNM was presented in 208 (82.5%) patients and level II-V LNM was present in 42.8%, 71.2%, 85.1%, 17.8% patients, respectively. BRAF V600E mutation was observed in 188 (74.6%) patients and was significantly associated with patients' age, lymphocytic thyroiditis, capsule invasion, bilateral central lymph node metastasis (CLNM) and level V LNM in PTC. Univariate analysis revealed that lymphocytic thyroiditis, tumor size, number of CLNM, Level II LNM, Level III LNM, simultaneous Level II+III, simultaneous Level III+IV and simultaneous Level II+III+IV were significantly correlated with Level V LNM. In addition, multivariate analysis revealed that tumor size ≥2.5 cm, number of CLNM≥3, level II metastases and BRAF V600E mutation were independent Level V LNM predictors (odds ratio 3.910, 3.660, 8.410, 0.439; 95% CI 1.737-10.135, 1.054-12.713, 1.233-57.355, 0.280-0.827, respectively). Conclusion: In summary, we presented several independent predictive factors for level V LNM in PTC patients. We constructed a risk prediction model consisting of tumor size ≥2.5 cm, number of CLNM≥3 and level II metastases and BRAF V600E mutation that may guide surgeons to evaluate the nodal status in PTC and perform tailored therapeutic LND.

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Section: Discussionmentioning

confidence: 99%

Predictive Factors for Level V Lymph Node Metastases in Papillary Thyroid Carcinoma with BRAFV600E Mutation and Clinicopathological Features

Li¹,

Tan²,

Chen³

et al. 2020

CMAR

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“…However, the rate of LNM has increased from 41% to 64%. 24 Although preoperative US is widely used, pathologically confirmed lymph nodes are not discovered before surgery. Kim et al.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for lymph node metastasis (LNM) in patients with papillary thyroid microcarcinoma (PTMC): role of preoperative ultrasound

et al. 2017

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ObjectiveThis study aimed to investigate the risk factors and clinical value of lymph node metastasis (LNM) and missed central lymph node metastasis (CLNM) using preoperative ultrasound (US) in patients with papillary thyroid microcarcinoma (PTMC).MethodsThis retrospective study included 521 patients who underwent thyroidectomy for confirmed PTMC based on a final histological examination between January 2014 and June 2015. Based on the presence of LNM, 521 cases were divided into two groups: metastasis (218) and non-metastasis (303). Univariate and multivariate logistic regression analyses were used to analyse the US and clinical characteristics of the primary tumour.ResultsWe defined LNM based on the tumour diameter with an optimal critical value of 0.55 cm using ROC analysis with a sensitivity of 65.6% and specificity of 59.6%. We defined US-missed CLNM based on the optimal critical value of 0.65 cm using diagnostic ROC analysis with a sensitivity of 66.0% and specificity of 73.0%. The odds ratios of significant factors with LNM by US were 10.3 (95% confidence interval [95% CI], 6.2–17.0), 5.3 (95% CI, 3.3–8.7), 2.7 (95% CI, 1.1–6.5), 4.3 (95% CI, 1.7–10.5), 2.5 (95% CI, 1.5–4.1), and 2.7 (95% CI, 1.7–4.4) for extrathyroidal invasion, blood flow, multifocality, tumour diameter greater than 0.55 cm, male sex, and age younger than 47 years, respectively.ConclusionsUS characteristics, such as extrathyroidal invasion, blood flow, tumour diameter, sex, and age, may improve the efficacy of predicting LNM and facilitating diagnosis of PTMC. Furthermore, tumour invasion to the extracapsular thyroid and a diameter greater than 0.65 cm indicate CLNM.

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“…The aim of our study was to evaluate the benefits of prophylactic ipsilateral CND with total thyroidectomy in cN0 PTC patients. Several studies have reported the risk factors of central and lateral neck LNM [7,14,16,17]. Male sex, age ( > 45 years), tumor size ( > 5 mm), lower lobe, total tumor diameter ( > 10 mm), and extracapsular spread were statistically significant factors for CLNM in multivariate analysis [7].…”

Section: Discussionmentioning

confidence: 92%

“…Several studies have reported the risk factors of central and lateral neck LNM [ 7 , 14 , 16 , 17 ]. Male sex, age (>45 years), tumor size (>5 mm), lower lobe, total tumor diameter (>10 mm), and extracapsular spread were statistically significant factors for CLNM in multivariate analysis [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

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The effectiveness of prophylactic ipsilateral central neck dissection in selected patients who underwent total thyroidectomy for clinically node-negative unilateral papillary thyroid carcinoma

Kang

Kim

Choi

et al. 2020

Yeungnam Univ J Med

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Background: Prophylactic central neck dissection (CND) in clinically node-negative (cN0) papillary thyroid carcinoma (PTC) remains controversial. The purpose of this study was to evaluate the benefits of prophylactic ipsilateral CND compared with bilateral CND in total thyroidectomy for cN0 unilateral PTC. Methods: We retrospectively enrolled 174 patients who underwent total thyroidectomies with prophylactic CND for cN0 unilateral PTC between January 2009 and May 2010. The prophylactic CND patients were divided into group 1, the ipsilateral CND group (n=74), and group 2, the bilateral CND group (n=100). The incidence of central lymph node metastasis (CLNM) and postoperative complications, such as hypoparathyroidism, recurrent laryngeal nerve injury, and recurrence were assessed. Results: CLNM was found in 22 (29.8%) in group 1 and 69 (69%) in group 2. The incidence of postoperative severe hypocalcemia less than 7.0 was also significantly different (six patients [8.1%] in group 1 and 23 [23%] in group 2; p=0.009). Permanent hypoparathyroidism was significantly more frequent in group 2 (4.1% vs. 19%; p=0.005). However, the incidence of transient hypoparathyroidism, recurrence, and recurrent laryngeal nerve injury was not significantly different. Conclusion: Prophylactic ipsilateral CND has advantage not only to reduce incidence of some complications but also to have similar recurrence rate compared with bilateral CND. We suggest that prophylactic ipsilateral CND may be safe and effective for selected patients undergoing total thyroidectomy for cN0 unilateral PTC.

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Prediction of central lymph node metastasis in 392 patients with cervical lymph node-negative papillary thyroid carcinoma in Eastern China

Cited by 17 publications

References 34 publications

<p>Predictive Factors for Level V Lymph Node Metastases in Papillary Thyroid Carcinoma with <em>BRAF</em><sup>V600E</sup> Mutation and Clinicopathological Features</p>

<p>Predictive Factors for Level V Lymph Node Metastases in Papillary Thyroid Carcinoma with <em>BRAF</em><sup>V600E</sup> Mutation and Clinicopathological Features</p>

Risk factors for lymph node metastasis (LNM) in patients with papillary thyroid microcarcinoma (PTMC): role of preoperative ultrasound

The effectiveness of prophylactic ipsilateral central neck dissection in selected patients who underwent total thyroidectomy for clinically node-negative unilateral papillary thyroid carcinoma

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