The Clinical Significance of the Right Para-Oesophageal Lymph Nodes in Papillary Thyroid Cancer

Chang, Hojin; Yoo, Ri Na; Kim, Seok Mo; Kim, Bup Woo; Lee, Yong Sang; Lee, Seung−Chul; Chang, Hang Seok; Park, Cheong Soo

doi:10.3349/ymj.2015.56.6.1632

Cited by 22 publications

(25 citation statements)

References 31 publications

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“…CLNM is common in DTC, with a frequency of 30-90% (17) and has been demonstrated to be closely associated with higher recurrence and poorer survival rates in patients with DTC (18). The majority of metastatic sites are located in central compartment lymph nodes, and complete central lymph node dissection has been identified to reduce the incidence of disease persistence, recurrence and mortality (19).…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes and associated factors of radioiodine-131 treatment in differentiated thyroid cancer with cervical lymph node metastasis

et al. 2018

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Abstract. Cervical lymph node metastasis (CLNM) is common in differentiated thyroid cancer (DTC). Radioiodine-131 ( 131 I) treatment is recommended for the removal of residual thyroid tissue following thyroidectomy. To date, the effect of 131 I therapy on the outcomes of patients with DTC with CLNM is unclear. The aim of the present study was to evaluate the final outcome of patients with DTC with CLNM according to 131 I administration, and to analyze the factors that may affect clinical outcomes. A total of 357 patients with DTC with CLNM were recruited and divided into three groups: Those who received 2, 3 or 4 doses of 131 I therapy, respectively. Successful ablation was defined as levels of stimulated serum thyroglobulin <2 ng/ml in the absence of CLNM. The rates of successful ablation were 80.35 (229/285), 76.36 (42/55) and 70.59% (12/17) for patients who received 2, 3 and 4 doses, respectively. The patients with DTC with CLNM who were <45 years old, with tumor sizes <2 cm, solitary nodules and TNM stage I-II disease exhibited significantly higher rates of successful ablation compared with the patients who were ≥45 years old, with tumor size ≥2 cm, multiple nodules and stage III-IV disease. Multivariate analyses revealed that tumor size, number of nodules and TNM stage were independent risk factors associated with successful ablation in patients with DTC with CLNM who received 2 doses of 131 I therapy. 131 I administration is a useful therapy to eradicate cervical lymph node metastasis in patients with DTC, and may be preferentially indicated in patients with DTC with CLNM who are aged <45 years, with tumor sizes <2 cm, solitary nodules and lower TNM stages, in order to control and prevent recurrence and/or metastases.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes and associated factors of radioiodine-131 treatment in differentiated thyroid cancer with cervical lymph node metastasis

et al. 2018

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“…[ 11 , 12 , 22 , 25 – 27 ] It has been reported that tumor size >1.0 cm was an independent predictor of LN-prRLN metastasis in patients with PTC. [ 12 , 27 ] Ito et al [ 28 ] reported that tumor size >2.0 cm was an important predictor of LN-prRLN metastases in patients with PTC in the right lobe. In the present study, LN-prRLN metastasis was more frequent in patients with tumor size >1 cm (20 of 32 cases, 62.5%), compared to patients with tumor size ≤1 cm (11 of 49 cases, 22.4%) ( P = .000).…”

Section: Discussionmentioning

confidence: 99%

Predictors of lymph nodes posterior to the right recurrent laryngeal nerve metastasis in patients with papillary thyroid carcinoma

Yuan¹,

Li²,

Chen³

et al. 2017

Medicine

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The aim of this study was to identify the risk factors associated with lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) metastasis in patients with papillary thyroid carcinoma (PTC).A total of 81 PTC patients who underwent total/near-total thyroidectomy with LN-prRLN dissection in the Department of General Surgery at Guangdong General Hospital between June 2015 and August 2016 were assessed retrospectively. The relations of LN-prRLN metastasis with clinicopathologic characteristics of PTC were analyzed by univariate and multivariate logistic regression.The incidence of LN-prRLN metastasis in patients with PTC was 51.9% (42 of 81 cases). Univariate analysis showed that lateral LN metastasis (P = .005), VIa central LN metastasis (P = .000), pathologic tumor size (P = .000), capsular invasion (P = .002), and extrathyroidal invasion (P = .018) (P < .05) were significantly associated with the increased incidence of LN-prRLN metastasis in PTC. No significant correlations were found between LN-prRLN metastasis and other variables such as gender (P = .056), age (P = .448), clinical N stage (cN) (P = .063), tumor location (P = .336), tumor site (P = .909), right tumor existence (P = .793), and multifocality (P = .381). Multivariate logistic regression analysis revealed that VIa central LN metastasis (OR: 4.490, P = .027) was independent risk factors of LN-prRLN metastasis in patients with PTC.LN-prRLN metastasis is often indentified in patients with PTC. VIa central LN metastasis is an independent predictors of LN-prRLN metastasis, which allow for selective LN-prRLN dissection in patients with PTC.

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“…According to this study and our clinical experience, we define the area posterior to the right RLN segment between laryngeal entry point and the intersection of the RLN with the innominate artery as the range of LN-prRLN dissection. Some researchers do not include the area above the level of the inferior thyroid artery in their LN-prRLN dissection to avoid injury of the right superior parathyroid and the associate blood supply [ 2 ]. However, this region usually includes some lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

“…Particularly, the incomplete resection of the lymph node posterior to the right recurrent laryngeal nerve in the first surgery can make the residual lymph nodes difficult to excise in the second surgery and even render the complete excision impossible. In this situation, patients who should have had a chance to be cured may thus lose the opportunity [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical value and indication for the dissection of lymph nodes posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma

Luo

Xu²,

Ding

et al. 2017

Oncotarget

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Lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) are common sites of nodal recurrence after the resection of papillary thyroid carcinoma (PTC). However, the indication for LN-prRLN dissection remains debatable. We therefore studied the relationships between LN-prRLN metastasis and the clinicopathological characteristics in 306 patients with right or bilateral PTC who underwent LN-prRLN dissection. We found that LN-prRLN metastasis occurred in 16.67% of PTC and was associated with a number of the clinicopathological features. The receiver-operator characteristic (ROC) analysis showed that the areas under the ROC curves for the prediction of LN-prRLN metastasis by the risk factors age < 35.5 years, right tumor size > 0.85 cm, lymph node (right cervical central VI-1) number > 1.5, metastatic lymph node (right cervical central VI-1) size > 0.45 cm, and lymph node number in the right cervical lateral compartment > 0.5 were 0.601, 0.815, 0.813, 0.725, and 0.743, respectively.In conclusion, the risk factors for LN-prRLN metastasis in patients suffering right thyroid lobe or bilateral PTC include age ≤ 35.5 years, right tumor size ≥ 0.85 cm, capsular invasion, metastatic lymph node (right cervical central VI-1) number ≥ 2, metastatic lymph node (right cervical central VI-1) size ≥ 0.45 cm, and metastatic lymph node number in the right cervical lateral compartment ≥ 1. In patients whose risk factors can be identified pre-operatively or intraoperatively, the dissection of LN-pr-RLN should be considered during right cervical central compartment dissection.

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The Clinical Significance of the Right Para-Oesophageal Lymph Nodes in Papillary Thyroid Cancer

Cited by 22 publications

References 31 publications

Clinical outcomes and associated factors of radioiodine-131 treatment in differentiated thyroid cancer with cervical lymph node metastasis

Clinical outcomes and associated factors of radioiodine-131 treatment in differentiated thyroid cancer with cervical lymph node metastasis

Predictors of lymph nodes posterior to the right recurrent laryngeal nerve metastasis in patients with papillary thyroid carcinoma

Clinical value and indication for the dissection of lymph nodes posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma

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