Subclinical lymph node metastasis in papillary thyroid microcarcinoma: A study of 551 resections

So, Yoon Kyoung; Son, Young‐Ik; Hong, Sang Duk; Seo, Min Young; Baek, Chung‐Hwan; Jeong, Han‐Sin; Chung, Man Ki

doi:10.1016/j.surg.2010.01.003

Cited by 184 publications

(194 citation statements)

References 33 publications

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“…(14,15) In this study, male sex was independently predictive of CLNM, in agreement with previous reports. Although the incidence of PTMC was higher among females in an epidemiological survey, males require specialized neck examinations to enable the early detection of thyroid tumors.…”

Section: Discussionsupporting

confidence: 93%

Factors Influencing Central Neck Lymph Node Metastasis in Patients with Papillary Thyroid Microcarcinoma

Kim

2016

Korean J Endocr Surg

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Purpose: A papillary thyroid microcarcinoma (PTMC) measures 1 cm or less in diameter. The diagnosis, and thus the apparent incidence, of PTMC has recently increased owing to an increase in the detection of subclinical small and low-risk carcinomas with ultrasonography and fine needle aspiration cytology. However, central neck lymph node metastasis (CLNM) can occur in patients with PTMC. We evaluated the factors influencing CLNM in patients with PTMC. Methods: We reviewed medical records including clinical information and pathologic reports, and analyzed 622 patients with PTMC who underwent thyroid surgery from January 2002 to December 2012. Results: CLNM was detected in 119 patients (19.1%) of the 622 with PTMC. Lymph node metastasis occurred more frequently in males (P=0.025), and those with bilateral tumors (P=0.016), more than two tumors (P=0.035), tumor size greater than 5 mm (P＜0.001), and lymphovascular invasion (P=0.024). There were no statistically significant differences in age and capsular invasion. Multivariate analysis showed that significant factors affecting lymph node metastasis included age at operation (odds ratio [OR]

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Section: Discussionsupporting

confidence: 93%

Factors Influencing Central Neck Lymph Node Metastasis in Patients with Papillary Thyroid Microcarcinoma

Kim

2016

Korean J Endocr Surg

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“…So et al reported that male sex, tumor multifocality, and extrathyroidal tumor extension; all were independent predictors of occult CLN metastases. 32 Considering tumor size as a risk factor for CLN metastasis, previous studies showed that larger tumor size was a risk factor for the presence of CLN metastasis in patients with PTC. 33 However, the size cutoffs differed in those studies but Suman et al, reported that larger tumors (tumor size >2cm) were significantly associated with CLN metastasis.…”

Section: Discussionmentioning

confidence: 99%

Papillary thyroid carcinoma, evaluation of prophylactic central compartment’s dissection versus conservative management: a prospective study

Ali

Abdelhameed

2018

Int Surg J

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INTRODUCTIONPTC is the most common well differentiated thyroid carcinoma (WDTC) and is considered a relatively indolent tumor.1 This relatively benign Behavior has led to a concept that CLND would not affect survival rates.2 Despite this, regional lymph node (LN) metastases are frequent in PTC occurring in 20% to 90% of patients. 3The pattern of LN metastasis takes place in a sequential manner; involving the central compartment (level VI) first with a frequency reaching 90% including micrometastases, followed by the ipsilateral lateral compartment and then the contralateral lateral compartment and the mediastinal LN. 4,5 Although there is consensus of block node dissection in node positive patients there is controversy about the benefits of elective CLND in N0 PTC. 6 Patients have a ABSTRACTBackground: Papillary thyroid carcinoma (PTC) is one of the commonest thyroid cancers. While there is consensus of block node dissection in nodal positive patients, there is controversy in dealing with nodal negative patients regarding the need of block node dissection. We aimed to evaluate prophylactic central lymph node dissection (pCLND) versus conservative management in PTC with N0 neck. Methods:This was a prospective randomized study conducted at General Surgery Department, Sohag University Hospital, from August 2013 to September 2017. It included fifty-five patients diagnosed to have PTC with N0 neck randomly divided into two groups; (Group A) included 25 patients who underwent total thyroidectomy (TT) alone and (Group B) included 30 patients who underwent TT with pCLND. We compared both groups regarding the operative and post-operative outcomes.Results: There was temporary hypoparathyroidism with an incidence of 12% for Group A and 23% for Group B (P=0.01). Permanent hypocalcemia occurred in 1 patient in each group (P=0.75). Unilateral recurrent laryngeal nerve (RLN) temporary palsy occurred in 10% for Group B patients and in 8% for Group A patients, (P=0.46). Node metastases were observed in 43% in group B upstaging the disease. Both univariate and multivariate analyses showed that CLN metastasis was significantly associated with age <45, male gender, tumor size >2.0cm, bilaterality, and multifocality. Locoregional recurrence was observed in 4% of patients in group A and in 0% in B.Conclusions: TT+pCLND is a safe treatment in patients with N0 PTC and it can be done without a high complication rate and without recurrence compared to TT without CLND.

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“…On experienced hands the elective (prophylactic) CCND carries almost the same rate of complications, except for temporary hypocalcaemia, where for every 7.7 CCNDs performed with thyroidectomy, there was one extra case of temporary hypocalcaemia when compared to thyroidectomy alone [19]. In literature, despite of the ATA recommendation for a selective indication for an elective CCND, we are observing an emerging number of studies, from different countries, showing good results with the use of an elective CCND for small and large PTCs [7,[20][21][22][23]. When indicated, the use of an ipsilateral CCND, described according to the ATA consensus statement on the anatomy and terminology of central neck dissection [24], showed a high therapeutic efficacy with a low incidence of complications, when compared with the bilateral procedure [25].…”

Section: Introductionmentioning

confidence: 99%

“…Then, a preoperative or intra-operative finding of minimal or massive extrathyroidal extension precludes the indication for a prophylactic CCND. Extra-thyroidal extension is associated with a higher incidence of central compartment subclinical lymph node metastasis in a frequency ranging from 21% to 43% [20,21,37].…”

Section: Introductionmentioning

confidence: 99%

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Elective Central Compartment Neck Dissection for Papillary Thyroid Cancer-Hot Topics

Teixeira¹

2012

J Nucl Med Radiat Ther

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Subclinical lymph node metastasis in papillary thyroid microcarcinoma: A study of 551 resections

Cited by 184 publications

References 33 publications

Factors Influencing Central Neck Lymph Node Metastasis in Patients with Papillary Thyroid Microcarcinoma

Factors Influencing Central Neck Lymph Node Metastasis in Patients with Papillary Thyroid Microcarcinoma

Papillary thyroid carcinoma, evaluation of prophylactic central compartment’s dissection versus conservative management: a prospective study

Elective Central Compartment Neck Dissection for Papillary Thyroid Cancer-Hot Topics

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