Risk Factors for Nodal Metastasis in cN0 Papillary Thyroid Microcarcinoma

Zhang, Liyang; Liu, Ziwen; Liu, Yue-Wu; Gao, Wenjing; Zheng, Congyi

doi:10.7314/apjcp.2015.16.8.3361

Cited by 28 publications

(13 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Zhang et al [ 38 ] suggested that the risk of CLNM reduced when the tumor was located in the upper thyroid, whereas Xiang et al [ 39 ] showed that the risk increased when the tumor was located in the middle thyroid. In this study, the interferences of multifocality and other factors were excluded.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of central lymph node metastasis of papillary thyroid carcinoma

Liu

Cheng

et al. 2017

Medicine

View full text Add to dashboard Cite

Due to the lack of an accurate preoperative diagnostic method of central lymph node metastasis (CLNM) of papillary thyroid cancer (PTC), the prophylaxis of central lymph node dissection remains controversial. The present study investigated the clinicopathological features of PTC patients and the risk factors of CLNM. The clinicopathological features of PTC patients with respect to sex, age, initial symptoms, observation, tumor diameter, multifocality, extrathyroidal invasion, and pathological data combined with other thyroid diseases, were analyzed retrospectively. The risk factors of CLNM were analyzed by Chi-squared test and multivariate logistic regression model. The CLNM rate of PTC was 40.6% (1331/3273). On average, 7.0 (4.0, 12.0) central lymph nodes were dissected, and 3.70 (±3.8) lymph nodes were proved to be metastatic. Univariate analysis showed that sex (P < .001), age (P < .001), tumor diameter (P < .001), extrathyroid invasion (P < .001), multifocality (P = .001), concurrent nodular goiter (P < .001), initial symptoms (P < .001), and observation or not (P < .001) were related to CLNM. The observation time was neither related to CLNM (P = .469) nor extrathyroidal invasion (P = .137). Tumors localized in the lower part of the thyroid were the risk factors for CLNM (P < .001) while multifocality was unrelated (P = .68). The metastasis rate of bilateral multiple regions > unilateral multiple regions > single region (P = .003). Multivariate logistic regression analysis showed that sex, age, tumor diameter, extrathyroidal invasion, and observation were independent risk factors of CLNM. Male, younger age, large tumor size, and extrathyroidal invasion were independent risk factors for CLNM. CLNM was related to multiple regions occupied by tumors in the thyroid but unrelated to multifocality. The tumor occupying a single region and localized in the lower part of thyroid could be used as a predictive factor for CLNM. For tumors that could not be diagnosed as benign or malignant, observation may be an option, since no evidence of disease progression was presented during observation.

show abstract

Section: Discussionmentioning

confidence: 99%

Risk factors of central lymph node metastasis of papillary thyroid carcinoma

Liu

Cheng

et al. 2017

Medicine

View full text Add to dashboard Cite

show abstract

“…Previous studies have reported tumour size as a risk factor for lymph node metastasis and recurrence. In general, tumour foci diameter >5 or 6 mm has appeared as an independent risk factor [ 6 , 20 , 21 , 23 , 24 ]. Therefore, patients with foci >6 mm in diameter should be followed up more closely.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have defined thyroid capsule invasion as extrathyroid or extracapsular spread, growth, extension, or invasion. Capsular invasion by PTM is an independent risk factor for tumour recurrence in the follow-up period [ 2 , 6 , 11 , 12 , 14 , 20 – 23 , 28 ]. Based on the rate of thyroid capsule invasion (5.4%) in the present study, we suggest that PTM with subcapsular localisation uncommonly invades the capsule of the thyroid gland.…”

Section: Discussionmentioning

confidence: 99%

Incidental Papillary Thyroid Microcarcinoma in an Endemic Goiter Area

Gürleyik

Gurleyik

Karapolat

et al. 2016

Journal of Thyroid Research

View full text Add to dashboard Cite

Clinical and pathological characteristics of incidental papillary thyroid microcancer cases, surgical, medical, and nuclear treatment methods, and patients' outcome were studied during follow-up period of 102 months. We studied 37 patients with incidental papillary thyroid microcancer (I-PTM). The surgical procedure was total thyroidectomy in 29 and hemithyroidectomy in 8 patients. Size, multifocality, and bilateralism of PTM foci, thyroid capsule invasion, and presence of lymphovascular invasion were histopathological parameters. We analysed adjuvant medical and nuclear treatment and patients' outcome during follow-up period of 102 (61–144) months. The prevalence rates of I-PTM were 9.4% in 395 thyroidectomy cases. Histopathological examination reported unifocal disease in 30 and multifocal disease in 7 (18%) patients. Multifocal disease was bilateral in 6 (20.1%) patients. The mean size of the PTM foci was 4.88 mm. The rate of thyroid capsule invasion was 5.4%. All patients received a suppressive dose of LT4 to achieve a low serum TSH level. Adjuvant surgical and nuclear treatment was not performed in our cases. We did not find any negative changes in blood chemistry and ultrasound imaging, and any unfavourable events as locoregional and systemic recurrence. In conclusion, diagnosis of I-PTM is common that multifocality and bilateralism appear as pathologic features. The prognosis is excellent after surgical treatment and TSH suppression. Routine adjuvant nuclear treatment is unnecessary in majority of patients.

show abstract

“…Our distinction of non-incidental microcarcinoma (>0.5 cm and ≤1 cm) and incidental microcarcinoma (≤0.5 cm) is in accordance with the separation points used in other analyses. [15][16][17][18][19][20]26 After exclusion of NIFTP, the indeterminate categories (FLUS+FN+SM) still accounted for the majority (60%) of preoperative FNA diagnoses for incidental microcarcinoma when compared to 25% for those of non-incidental microcarcinoma (p<0.05, chi-square test) ( Table 2).…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

Fine-needle aspirates of thyroid microcarcinoma

Partyka

2017

Journal of the American Society of Cytopathology

View full text Add to dashboard Cite

Precis:In our experience, indeterminate diagnoses (FLUS+FN+SM) accounted for the majority (60%) of preoperative FNAs for incidental microcarcinoma (size ≤0.5 cm) when compared to 27% for those of non-incidental microcarcinoma (size >0.5 cm and ≤1 cm) (p<0.05, chi-square test). ABSTRACT: INTRODUCTION:Widespread use of ultrasound allows for detection of smaller thyroid nodules and preoperative evaluation with fine-needle aspiration (FNA). Both incidental and non-incidental microcarcinoma can be found, leading to uncertainty with clinical management. MATERIALS AND METHODS:A retrospective analysis of thyroid FNAs performed at our institution was conducted for the 5year period from 2010 to 2014. Aspirates were categorized using the Bethesda System for Reporting Thyroid Cytopathology. Cytologic diagnoses were then correlated with final histopathology. Among samples with malignancy on surgical resection, nodules were stratified by size. RESULTS:A total of 2531 thyroid FNAs were identified. 587 samples had histologic correlation, and 259 malignancies were reported. They were separated into nodules >1 cm (n=144, 56%) and ≤1 cm (n=115, 44%). Microcarcinoma was further subdivided into incidental (size ≤0.5 cm, n=55, 48%) and non-incidental (size >0.5 cm and ≤1 cm, n=60, 52%). The preoperative cytologic diagnoses for incidental microcarcinoma were: benign (B, n=11, 20%), follicular lesion of undetermined significance (FLUS, n=15, 27%), follicular neoplasm (FN, n=11, 20%), suspicious for malignancy (SM, n=7, 13%), malignant (M, n=8, 15%), and non-diagnostic (ND, n=3, 5%). The FNA categories for non-incidental microcarcinoma were: B (n=13, 22%), FLUS (n=3, 5%), FN (n=3, 5%), SM (n=10, 17%), M (n=29, 48%) and ND (n=2, 3%). CONCLUSIONS:Incidental microcarcinoma is not an uncommon entity, making up 21% (55/259) of malignant nodules on thyroidectomy. Indeterminate diagnoses (FLUS+FN+SM) accounted for the majority

show abstract

Risk Factors for Nodal Metastasis in cN0 Papillary Thyroid Microcarcinoma

Cited by 28 publications

References 20 publications

Risk factors of central lymph node metastasis of papillary thyroid carcinoma

Risk factors of central lymph node metastasis of papillary thyroid carcinoma

Incidental Papillary Thyroid Microcarcinoma in an Endemic Goiter Area

Fine-needle aspirates of thyroid microcarcinoma

Contact Info

Product

Resources

About