Prognostic value of tumor size and minimal extrathyroidal extension in papillary thyroid carcinoma

Shin, Chang–Ho; Roh, Jong–Lyel; Song, Dong Eun; Cho, Kyung–Ja; Choi, Seung‐Ho; Nam, Soon Yuhl; Kim, Sang Yoon

doi:10.1016/j.amjsurg.2020.02.020

Cited by 25 publications

(27 citation statements)

References 36 publications

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“…Therefore, we hypothesized that ACB may be biologically more aggressive and have a higher recurrence rate than EACB. Similar to this hypothesis, it has been reported that spinal CB is more aggressive and more prone to recurrence than extremity bone CB [9][10][11] ; in addition, our study also found that the size of tumors and the incidence of surrounding tissue invasion were greater in ACB patients than in EACB patients, and a larger tumor size and higher surrounding tissue invasion rate indicated high tumor aggressiveness and poor prognosis 22,23 . In addition, ACB patients are also more likely to develop sensory or motor dysfunction, which is not di cult to understand.…”

Section: Differences In Immunohistopathological and Clinicopathologic...supporting

confidence: 90%

Clinicopathological Characteristics and Prognostic Factors in Axial Chondroblastomas: A Retrospective Analysis of 61 Cases and Comparison with Extra-Axial Chondroblastomas

Zheng

Niu

et al. 2022

Preprint

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Background The clinical characteristics and prognostic factors of axial chondroblastoma (ACB) are still poorly understood. Purpose To characterize clinicopathological characteristics in a large ACB cohort and investigate their correlation with survival. We also sought to compare these results with extra-axial CB (EACB). Methods Our institution's local database was retrospectively reviewed and included a total of 132 CB patients, including 61 ACB patients and 71 EACB patients. Immunohistochemistry was used to assess the expression levels of Vimentin (Vim), S100, and cytokeratin (CK) on tumor cells in 132 tissue specimens. Results Overall, ACB and EACB had similar characteristics, except for older age and tumor size, as well as higher Vim expression, incidence of surrounding tissue invasion and postoperative sensory or motor dysfunction. Whereas wide resection and absence of invasion of surrounding tissues were consistently associated with favorable survival in the ACB and EACB cohorts in univariate analysis, most parameters showed differential prognostic significance between the 2 groups. Significant prognostic factors for local recurrence-free survival in multivariate analysis included the type of resection and chicken-wire calcification in the ACB cohort. Multivariate analysis of overall survival demonstrated that the type of resection was a significant predictor in the ACB cohort, whereas the type of resection and postoperative sensory or motor dysfunction were predictive of overall survival in the EACB group. Conclusion These data suggest that there may be distinct biological behaviors between ACB and EACB and may provide useful information to better understand the prognostic characteristics of patients with ACB and to improve outcome prediction in patients with ACB.

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Section: Differences In Immunohistopathological and Clinicopathologic...supporting

confidence: 90%

Clinicopathological Characteristics and Prognostic Factors in Axial Chondroblastomas: A Retrospective Analysis of 61 Cases and Comparison with Extra-Axial Chondroblastomas

Zheng

Niu

et al. 2022

Preprint

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“…In several tumor entities, LVI has been shown to correlate with LNMs and with prognoses of patients (13)(14)(15)(16)(17)(18). Similar data are available for PTC (6,(19)(20)(21)(22)(23)(24). However, LVI does not play a role in clinical decision-making according to all major guidelines and is not mandatory in pathology reports of PTC according to the current TNM classification (28).…”

Section: Discussionmentioning

confidence: 92%

“…L0 was suggested as a possible argument for omitting prophylactic lymphadenectomy in these patients (18). Although there is some evidence that LVI in PTC correlates with LNMs (19)(20)(21)(22) and with outcomes of patients (6,23,24), LVI does not play any concrete role in clinical decision-making. Vascular invasion instead is included among those crucial histologic variables for initial risk stratification and clinical management of PTC, alongside ETE, margin status (R), and the number of metastatic lymph nodes (pN-status) (25)(26)(27).…”

Section: Introductionmentioning

confidence: 99%

Lymphatic Vessel Invasion in Routine Pathology Reports of Papillary Thyroid Cancer

et al. 2022

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PurposeIt is not mandatory to report lymphatic vessel invasion in pathology reports of papillary thyroid cancer (PTC) according to the current Union for International Cancer Control (UICC) TNM (tumor, nodes, and metastases) classification. However, there is some evidence for its correlation with lymph node metastasis (LNM) and prognosis. The aim of this study was to explore the clinical implication of lymphatic vessel invasion documentation of PTC because pathology reports play a pivotal role in postsurgical clinical decision-making in endocrine tumor boards.MethodsPatients undergoing postoperative radioiodine treatment for PTC at the University Hospital of Cologne, Germany between December 2015 and March 2020 were identified. Pathology reports were screened for documentation of lymphatic vessel invasion. Demographics and clinicopathologic data of patients documented, including lymphatic vessel invasion and lymph nodal involvement were analyzed.ResultsA total of 578 patients were identified and included. Lymphatic vessel invasion was reported in pathology reports of 366 (63.3%) and omitted in 112 (36.7%) patients. Positive lymphatic vessel invasion (L1) was diagnosed in 67 (18.3%) of 366 patients and was documented as absent (L0) in 299 (81.7%) patients. Lymph nodal (N) status was positive (N+) in 126 (45.6%) and negative (N0) in 150 (54.3%) of these patients. In 54 (80.6%) L1 cases N+ status and in 137 (65.6%) L0 cases N0 status was diagnosed. In 13 (19.4%) cases with L1 status, there were no LNMs (L1 N0). In total, 72 (34.4%) patients had LNM despite L0 status (L0 N+). The sensitivity and specificity of LVI reporting for LNM were 0.42 and 0.91, respectively.ConclusionIn routine pathology reports of PTC used for indication to postoperative radioiodine treatment by a German endocrine tumor board, lymphatic vessel invasion was found to be reported inconsistently and mostly as L0. L1 diagnoses, however, reliably correlated with reported LNM and might, thus, be relevant for clinical decision-making. For this reason, we advocate for standardized pathologic reassessment of lymphatic vessel invasion, in particular for cases where lymph nodes are not included in the pathologic specimen and if L0 is documented.

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“…ETE was another important variable affecting LN metastasis and disease recurrence in PTC. Its extent was categorized as macroscopic invasion, if invasion was limited to only strap muscles, and macroscopic maximal invasion, if invasion extended beyond the strap muscles ( 22 ). In accordance with the American Joint Committee on Cancer staging system, irrespective of the tumor size, patients with ETE were classified into T3 or T4.…”

Section: Discussionmentioning

confidence: 99%

Unnecessity of Routine Dissection of Right Central Lymph Nodes in cN0 Papillary Thyroid Carcinoma Located at the Left Thyroid Lobe

Zhang

Wang

et al. 2021

Front. Oncol.

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ObjectiveThe lymph node posterior to the right recurrent laryngeal nerve (LN-prRLN) is an important part of the central lymph nodes (LNs). We aimed to explore the rate and predictors of LN-prRLN metastasis in cN0 papillary thyroid carcinoma (PTC) located at the left thyroid lobe.MethodsPatients with surgically treated primary left lobe PTC were retrospectively enrolled. The metastatic distribution of LN-prRLN and postoperative complications were assessed. The association between LN-prRLN metastasis and clinicopathological variables was evaluated by univariate and multivariate analyses.ResultsA total of 857 patients were included for the analysis. Central LN metastasis was noted in 310 (35.3%) cases. The most (27.6%) and least (1.7%) commonly involved LNs were the left paratracheal LN and the LN-prRLN. In the univariate analysis, the tumor size, multifocality, the extent of extrathyroidal extension (none vs. macroscopic vs. macroscopic maximal), and perineural invasion were associated with positive LN-prRLN. In the multivariate analysis, tumor size of >40.0 mm and macroscopic maximal invasion were found as the only two independent predictors. Transient and permanent hypoparathyroidism were noted in 90 (10.2%) and 13 (1.5%) patients, respectively. Voice change was noted in 40 (4.6%) patients, and 20 patients recovered.ConclusionsIn cN0 PTC located at the left lobe, LN-prRLN metastasis was very uncommon. We found that LN-prRLN dissection is not required routinely, but should be performed if the tumor size is >40.0 mm and macroscopic maximal extrathyroidal extension is present.

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Prognostic value of tumor size and minimal extrathyroidal extension in papillary thyroid carcinoma

Cited by 25 publications

References 36 publications

Clinicopathological Characteristics and Prognostic Factors in Axial Chondroblastomas: A Retrospective Analysis of 61 Cases and Comparison with Extra-Axial Chondroblastomas

Clinicopathological Characteristics and Prognostic Factors in Axial Chondroblastomas: A Retrospective Analysis of 61 Cases and Comparison with Extra-Axial Chondroblastomas

Lymphatic Vessel Invasion in Routine Pathology Reports of Papillary Thyroid Cancer

Unnecessity of Routine Dissection of Right Central Lymph Nodes in cN0 Papillary Thyroid Carcinoma Located at the Left Thyroid Lobe

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