Predictors of Central Compartment Involvement in Patients with Positive Lateral Cervical Lymph Nodes According to Clinical and/or Ultrasound Evaluation

Abstract

Lymph node neck metastases are frequent in papillary thyroid carcinoma (PTC). Current guidelines state, on a weak level of evidence, that level VI dissection is mandatory in the presence of latero-cervical metastases. The aim of our study is to evaluate predictive factors for the absence of level VI involvement despite the presence of metastases to the lateral cervical stations in PTC. Eighty-eight patients operated for PTC with level II–V metastases were retrospectively enrolled in the study. Demographics, thyroid function, autoimmunity, nodule size and site, cancer variant, multifocality, Bethesda and EU-TIRADS, number of central and lateral lymph nodes removed, number of positive lymph nodes and outcome were recorded. At univariate analysis, PTC location and number of positive lateral lymph nodes were risk criteria for failure to cure. ROC curves demonstrated the association of the number of positive lateral lymph nodes and failure to cure. On multivariate analysis, the protective factors were PTC located in lobe center and number of positive lateral lymph nodes < 4. Kaplan–Meier curves confirmed the absence of central lymph nodes as a positive prognostic factor. In the selected cases, Central Neck Dissection (CND) could be avoided even in the presence of positive Lateralcervical Lymph Nodes (LLN+).

The proposed modification of TNM staging and therapeutic strategy for skip metastasis in papillary thyroid carcinoma: A multicenter retrospective cohort study

“…In this scenario, unilateral PTC patients with highly suspected or intraoperative pathological diagnosed skip metastasis may benefit more from thyroid lobectomy (TL) with therapeutic compartmental lateral neck dissection instead of total thyroidectomy (TT) 33,34 . Recent research showed that N1b patients with no evidence of CLNM might not require or benefit from prophylactic CND, which provided patients with skip metastasis a possibility of less aggressive treatment strategy 35,36 . In terms of adjunctive treatment, routine RAI and moderate or complete TSH‐suppressive therapy may not be necessary as well.…”

“… 33 , 34 Recent research showed that N1b patients with no evidence of CLNM might not require or benefit from prophylactic CND, which provided patients with skip metastasis a possibility of less aggressive treatment strategy. 35 , 36 In terms of adjunctive treatment, routine RAI and moderate or complete TSH‐suppressive therapy may not be necessary as well. Although the population of skip metastasis patients is not large, huge improvements in physiological, psychological, and social benefits are worthy.…”

Papillary Thyroid Microcarcinoma: Active Surveillance Against Surgery. Considerations of an Italian Working Group From a Systematic Review

“…It should also be noted that micro pT3 makes up 25% of all pT3, and up 15% of all PTmC. In the light of current knowledge, more aggressive treatment is considered mandatory for these tumors ( 29 , 30 ).…”

Clinical Usefulness of the Valsalva Manoeuvre to Improve Hemostasis during Thyroidectomy

“…Bleeding after thyroidectomy is a well-known complication, but thanks to improvements in haemostasis, it has become a rare occurrence. However, despite its rarity, if bleeding is not diagnosed early and correctly managed it can become a potentially life-threatening condition [ 8 , 9 , 10 ].…”