The extent of lymph node yield in central neck dissection can be affected by preoperative and intraoperative assessment and alter the prognosis of papillary thyroid carcinoma

Hu, Jia‐Qian; Wen, Duo; Ma, Ben; Zhang, Tingting; Liao, Tian; Shi, Xiao; Wang, Yulong; Zhu, Yixin; Wei, Wenjun; Ji, Qinghai

doi:10.1002/cam4.2762

Cited by 11 publications

(13 citation statements)

References 21 publications

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“…We therefore further evaluated the predictive factors for the lateral multiple-metastasis in N1b PTMC. Other studies (4,14,28) have reported that CPLN was a predictor of lateral LNM in PTC patients. Xiao et al (29) conducted ipsilateral LND for PTC patients and demonstrated that CPLN ≥ 2 was a reliable indicator of lateral LNM.…”

Section: Discussionmentioning

confidence: 88%

Management of Lateral Multiple-Level Metastasis in N1b Papillary Thyroid Microcarcinoma

et al. 2020

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Background: The optimal extent of therapeutic lateral neck dissection (LND) in the management of N1b papillary thyroid microcarcinoma (PTMC) is still under debate in clinical practice. In this light, our study aims to explore the incidence, patterns, and predictive factors of the lateral multiple-level metastasis in N1b PTMC patients. Methods: The clinical records of 142 patients diagnosed with N1b PTMC who underwent therapeutic LND from July 2015 to November 2018 at our institution were retrospectively reviewed. Univariate and multivariate analyses were conducted to examine the predictive factors associated with lateral multiple-level metastasis. The recurrence-free survival was analyzed and confirmed by Kaplan–Meier plots and log-rank test. Results: The overall frequency of lateral multiple-level metastasis was 50.7% in N1b PTMC patients, and two-level to four-level simultaneous metastasis were present in 26.8, 17.6, and 6.3% patients, respectively. Extrathyroidal extension (ETE) (OR = 5.79, 95% CI, 1.36–24.59; P = 0.017) and the central metastatic lymph node ratio (CLNR) with values equal or higher than 0.61 (OR = 6.18, 95% CI, 2.53–15.09; P < 0.001) served as independent predictors of multiple-level metastasis in N1b PTMC patients. Moreover, locoregional recurrence was significantly higher in the selective neck dissection (SND) group compared to the modified radical neck dissection (MRND) one (HR = 3.65, 95% CI, 1.11–12.00; P = 0.03). Conclusion: Our results show that the lateral multiple-level metastasis was relatively common, and we suggest MRND to be considered for N1b PTMC patients with ETE or CLNR equal or higher than 0.61.

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Section: Discussionmentioning

confidence: 88%

Management of Lateral Multiple-Level Metastasis in N1b Papillary Thyroid Microcarcinoma

et al. 2020

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“…Generally, PTC has an excellent prognosis, but neck lymph node metastases (LNM) are quite common, which increases the risk of tumor relapse and reduce long-term survival (2)(3)(4). Evaluating LNM accurately is thus essential for appropriate initial surgical management (5,6). The Delphian lymph node (DLN) (prelaryngeal lymph node) was named by the "Oracle of Delphi" (7), the most famous religious prophet in the temple of Apollo of ancient Greek times.…”

Section: Introductionmentioning

confidence: 99%

Clinical implications of Delphian lymph node metastasis in papillary thyroid carcinoma

Zhu¹,

Huang²,

Yü³

et al. 2021

Gland Surg

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Background: As is known, identifying risk factors precisely for lymph node metastasis (LNM) plays a vital role in initial treatment for papillary thyroid carcinoma (PTC). Nonetheless, whether Delphian lymph node (DLN) metastasis has value in predicting LNM remains an open question. This study covered a sample of 1,575 patients, which is the largest sample group so far, aiming to assess the predictive validity of DLN metastasis in PTC. Methods: This retrospective cohort study was conducted with 1,575 eligible PTC patients who underwent thyroid operation between July 2013 and December 2018 and clinicopathologic parameters of patients with DLN metastasis were compared with those without DLN metastasis. Results: The incidence of DLN metastasis, according to our research samples, is 24.4% (384/1,575 patients). And results show that DLN positivity was closely associated with adverse prognostic factors including younger age, larger tumor size, extrathyroid extension, tumor location in the isthmus or upper lobe of the thyroid, number of LNM >5, higher recurrence. After carefully adjusting important confounding factors, we find that in multivariate logistic regression analyses, DLN metastasis is an independent predictor for both central LNM (CLNM, adjusted OR =7.81, P<0.001) and lateral LNM (LLNM, adjusted OR =3.40, P<0.001). Moreover, the stratified analyses also show convincing evidence of a positive correlation between DLN metastasis and LNM in levels II-IV in the vast majority of subgroups.Conclusions: The present study suggests that DLN metastasis is an independent risk factor for CLNM and LLNM of levels II-IV. The cervical lymph nodes should be meticulously evaluated to guide tailored treatment during operation in patients with DLN involvement.

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“…Thyroid surgery is known to encompass a broad range from benign causes to malignant causes, which can vary from limited thyroidectomy to central or lateral LN dissection. A previous study reported that the incidence of nerve damage seen could show a difference depending on the extent of the surgery [ 3 ]. Although nerve damage can develop associated with traction or thermal causes, it has been reported that in patients where neck dissection is performed, there is a higher risk associated with invasion of metastatic LNs [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…The basic treatment of PTC where there is LNM is full resection of the primary tumor and regional LNM [ 2 ]. Depending on the level of lymphatic spread, central or modified radical lymph node dissection (MLND) are the treatment options used in surgery [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

The effect of intraoperative neuromonitoring on the number of lymph nodes excised and recurrence when applied during neck dissection in cases of papillary thyroid cancer

2022

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Purpose The aim of this study was to evaluate the effect of neuromonitoring on the number of lymph nodes (LNs) removed when applied during neck dissection. Methods A total of 166 patients receiving neck dissection due to papillary thyroid cancer were separated into 2 groups (monitoring group, n = 76; non-monitoring group, n = 90). Results The number of LNs dissected was observed to be statistically significantly higher in the monitoring group (P = 0.001), and the difference between the groups in the number of positive LNs was significant (P = 0.031). There was seen to be a negative relationship between the number of positive LNs dissected and recurrence (r = –0.404, P = 0.005). Conclusion Intraoperative neuromonitoring during neck dissection makes a positive contribution to the prevention of the development of recurrence by increasing the number of LNs excised and the number of metastatic LNs.

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The extent of lymph node yield in central neck dissection can be affected by preoperative and intraoperative assessment and alter the prognosis of papillary thyroid carcinoma

Cited by 11 publications

References 21 publications

Management of Lateral Multiple-Level Metastasis in N1b Papillary Thyroid Microcarcinoma

Management of Lateral Multiple-Level Metastasis in N1b Papillary Thyroid Microcarcinoma

Clinical implications of Delphian lymph node metastasis in papillary thyroid carcinoma

The effect of intraoperative neuromonitoring on the number of lymph nodes excised and recurrence when applied during neck dissection in cases of papillary thyroid cancer

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