Abstract
This study was designed to determine the incidence and predictive factors for lateral lymph node metastasis (LNM) in patients with papillary thyroid microcarcinoma (PTMC). From January 2014 to July 2015, a retrospective review was conducted of 215 patients with PTMC who underwent total thyroidectomy and central lymph node dissection (LND) with lateral LND. Correlations of lateral LNM with clinicopathological features were examined using univariate analyses. Risk factors for lateral LNM were identified by multivariate analysis. Lateral LNM was observed in 163(75.8%) cases of 215 patients and often involved in level III (82.2%) and level IV (65.6%), with most found in two-levels (41.1%) and single-level (33.7%) models. Multivariate analyses showed that central LNM (odds ratio [OR]: 8.28, 95% confidence interval [CI]: 3.43–19.98, p < 0.001) and upper portion location (OR: 2.87 [CI: 1.34–6.09]; p = 0.007) were independent predictive factors for lateral LNM. The incidence of skip metastasis-Lateral LNM with central Lymph nodes negative-was 8.6% (14/163). Age ≥ 45 years old (OR: 4.37 [CI: 1.14–16.66]; p = 0.031) and upper portion location (OR: 4.34 [CI: 1.27–14.78]; p = 0.019) were independent risk factors for skip metastasis by multivariate analyses. Taken together, patients with PTMC with central LNM and tumor in the upper pole were more likely to present with lateral LNM. Even if there was no central LNM, patients with an age ≥ 45 years old and tumors in the upper portion of the thyroid should be evaluated carefully for possible lateral LNM.
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References
Yu XM, Wan Y, Sippel RS, Chen H (2011) Should all papillary thyroid microcarcinomas be aggressively treated? An analysis of 18,445 cases. Ann Surg 254:653–660
Chow SM, Law SC, Chan JK, Au SK, Yau S, Lau WH (2003) Papillary microcarcinoma of the thyroid: prognostic significance of lymph node metastasis and multifocality. Cancer 98:31–40
Pisanu A, Reccia I, Nardello O, Uccheddu A (2009) Risk factors for nodal metastasis and recurrence among patients with papillary thyroid microcarcinoma: differences in clinical relevance between nonincidental and incidental tumors. World J Surg 33:460–468
Hay ID, Hutchinson ME, Gonzalez Losada T (2008) Papillary thyroid microcarcinoma: a study of 900 cases observed in a 60-year period. Surgery 144:980–988
Machens A, Hinze R, Thomusch O, Dralle H (2002) Pattern of nodal metastasis for primary and reoperative thyroid cancer. World J Surg 26:22–28
Shaha AR (1998) Management of the neck in thyroid cancer. Otolaryngol Clin N Am 31:823–831
Machens A, Holzhausen H, Dralle H (2004) Skip metastases in thyroid cancer leaping the. Central lymph node compartment. Arch Surg 139:43–45
Lim YC, Koo BS (2012) Predictive factors of skip metastases to lateral neck compartment. Leaping central neck compartment in papillary thyroid carcinoma. Oral Oncol 48:262–265
Lee YS, Shin SC, Lim YS et al (2014) Tumor location–dependent skip lateral cervical lymph node metastasis in papillary thyroid cancer. Head Neck 36:887–891
Wada N, Duh QY, Sugino K et al (2003) Lymph node metastasis from 259 papillary. Thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg 237:399–407
Kim YS (2012) Patterns and predictive factors of lateral lymph node metastasis in papillary thyroid microcarcinoma. Otolaryngol Head Neck Surg 147:15–19
Chung YS, Kim JY, Bae JS et al (2009) Lateral lymph node metastasis in papillary thyroid carcinoma: results of therapeutic lymph node dissection. Thyroid 19:241–246
Kim TY, Hong SJ, Kim JM et al (2008) Prognostic parameters for recurrence of papillary thyroid microcarcinoma. BMC Cancer 8:296
Pelizzo MR, Boschin IM, Toniato A et al (2004) Natural history, diagnosis, treatment and outcome of papillary thyroid microcarcinoma (PTMC): a mono-institutional 12-year experience. Nucl Med Commun 25:547–552
Roh JL, Kim JM, Park CI (2008) Lateral cervical lymph node metastases from papillary thyroid carcinoma: pattern of nodal metastases and optimal strategy for neck dissection. Ann Surg Oncol 15:1177–1182
Kwak JY, Kim EK, Kim MJ et al (2009) Papillary microcarcinoma of the thyroid: predicting factors of lateral neck node metastasis. Ann Surg Oncol 16:1348–1355
Lee KJ, Cho YJ, Kim SJ et al (2011) Analysis of the clinicopathologic features of papillary thyroid microcarcinoma based on 7-mm tumor size. World J Surg 35:318–323
Yang Y, Chen C, Chen Z et al (2014) Prediction of central compartment lymph node metastasis in papillary thyroid microcarcinoma. Clin Endocrinol 81:282–288
Zeng RC, Li Q, Lin KL et al (2012) Predicting the factors of lateral lymph node metastasis in papillary microcarcinoma of the thyroid in eastern China. Clin Transl Oncol 14:842–847
Kwak JY, Kim EK, Youk JH et al (2008) Extrathyroid extension of well-differentiated papillary thyroid microcarcinoma on US. Thyroid 18:609–614
Lim YS, Lee JC, Lee YS et al (2011) Lateral cervical lymph node metastases from papillary thyroid carcinoma: predictive factors of nodal metastasis. Surgery 150:116–121
Lin KL, Wang OC, Zhang XH, Dai XX, Hu XQ, Qu JM (2010) The BRAF mutation is predictive of aggressive Clinicopathological characteristics in papillary thyroid microcarcinoma. Ann Surg Oncol 17:3294–3300
Ito Y, Tomoda C, Uruno T et al (2004) Papillary microcarcinoma of the thyroid: how should it be treated? World J Surg 28:1115–1121
Chung YS, Kim JY, Bae JS et al (2009) Lateral lymph node metastasis in papillary thyroid carcinoma: results of therapeutic lymph node dissection. Thyroid 19:241–245
Verburg FA, Mader U, Tanase K et al (2013) Life expectancy is reduced in differentiated thyroid cancer patients≥45 years old with extensive local tumor invasion, lateral lymph node, or distant metastases at diagnosis and normal in all other DTC patients. J Clin Endocrinol Metab 98:172–180
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This work was supported by the grants from the CAMS Innovation Fund for Medical Sciences (CIFMS, 2016-I2M-3-005).
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The study protocol was approved by the Institutional Review Board of the Peking Union Medical College Hospital and conducted in accordance with Helsinki’s Declaration.
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Informed consent was obtained from all patients included in the study.
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Ge Chen and Yupei Zhao were co-corresponding authors
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Zhao, W., Chen, S., Hou, X. et al. Predictive Factors of Lateral Lymph Node Metastasis in Papillary Thyroid Microcarcinoma. Pathol. Oncol. Res. 25, 1245–1251 (2019). https://doi.org/10.1007/s12253-018-0511-8
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DOI: https://doi.org/10.1007/s12253-018-0511-8