Risk of bilateral cervical lymph node metastases in papillary thyroid cancer

Abstract

We evaluated the risk of bilateral or contralateral cervical lymph node metastases in 135 patients with papillary thyroid cancer who underwent bilateral neck dissection. We confirmed that bilateral jugular lymph node metastases were frequent in patients with obvious carcinoma in both lobes of the gland, in those with cancers arising in the isthmus, in those with clinically detectable bilateral lymphadenopathy, and in those with recurrent thyroid cancer. However, only 24% of the patients who had cancer clinically confined to one lobe with no bilateral or contralateral lymphadenopathy had histologically detected bilateral or contralateral jugular lymph node metastases. But the occurrence of contralateral jugular lymph node metastases was significantly correlated with both clinical lymphadenopathy in the ipsilateral neck and contralateral paratracheal lymph node metastases. Bilateral lymph dissection might be beneficial for these patients.

Sentinel lymph node biopsy as guidance for central neck dissection in patients with papillary thyroid carcinoma

“…The lower rate reported here may have been caused by the greater proportion of patients with low-risk factors and small tumors. 1,5,22 Although subclinical lymph node metastases are identified in a high proportion of patients with PTC, 23,24 the management of macroscopic lymph node-negative tumors of the neck remains unclear. Because of the relatively high cervical recurrence rate (31%) 3 and the negative impact of lymph node metastases on disease-free survival, 25 ipsilateral modified radical neck dissection after thyroid resection may be indicated.…”

“…W ell differentiated papillary thyroid carcinoma (PTC) has a high propensity to spread to regional lymph nodes, with a frequency as high as 82% in patients with clinically negative lymph nodes (cN0). 1 Because lymph node metastasis has not been considered prognostic for poor survival, its management is controversial. 2 However, cervical lymph node recurrences have been reported in up to 31% of patients.…”

Pro und Contra Lymphadenektomie beim papillären und follikulären Schilddrüsenkarzinom

“…PTC ko Ènnen verschiedene histologische Varianten ausbilden (Kapselbildung, follikula Ère oder diffus sklerosierende Anteile, unterschiedliche Zellformen), welche stets die typischen Milchglaskerne aufweisen. Eine Besonderheit der PTC ist der hohe Anteil an multizentrischen intraglandula Èren (20±80 %) und bilateralen (30 %) Karzinomen [26,37]. Jodspeicherungsfa Èhigkeit und Thyreoglobulinsynthese sind weitere funktionelle Merkmale der PTC [47].…”

“…Die Inzidenz von synchronen Lymphknotenmetastasen korreliert mit der intraglandula Èren Multizentrizita Èt [20,26]. Synchrone Lymphknotenmetastasen treten mit einer Ha Èufigkeit von 60±90 % auf, d. h. zum Zeitpunkt der Diagnosestellung lassen sich bei 90 % der Patienten bereits Lymphknotenmetastasen nachweisen.…”

“…Die Mehrzahl der Autoren fand jedoch fu Èr das PTC in uni-und multivariaten Analysen einen positiven Effekt auf das Gesamtu Èberleben und die Rezidivha Èufigkeit bei der Durchfu Èhrung einer totalen Thyreoidektomie und systematischen Lymphadenektomie [8,26,27,35,43]. D. h. die LKM stellt einen relevanten Prognosefaktor dar.…”