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Solitary lateral neck node metastasis in papillary thyroid carcinoma.

Kim SM, Chun KW, Chang HJ, Kim BW, Lee YS, Chang HS, Park CS - World J Surg Oncol (2014)

Bottom Line: The clinicopathologic characteristics of the two groups were compared.Mean primary tumor size was significantly smaller in the SLNM than in the MNLM group (1.03 cm versus 1.35 cm; P=0.037).The proportion of patients with primary tumor≤1 cm was significantly greater in the SLNM group (60.8% versus 38.4%; P=0.006), whereas the proportion with maximal node size≤0.7 cm (28.9% versus 73.3%; P<0.001) and the proportion with capsular invasion (62.7% versus 83.7%, P=0.002) were significantly lower in the SLNM than in the MLNM group.

View Article: PubMed Central - HTML - PubMed

Affiliation: Thyroid Cancer Center, Department of Surgery, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu 135-720, Seoul, Korea. SURGHSC@yuhs.ac.

ABSTRACT

Background: Papillary thyroid carcinoma (PTC) is associated with a high incidence of regional node metastasis, but the patterns of lateral neck node metastasis (LNM) vary. Occasionally, a solitary LNM (SLNM) is seen in PTC patients. We therefore assessed whether selective single level node dissection is appropriate in PTC patients with SLNM.

Methods: We retrospectively reviewed the medical records of 241 PTC patients who underwent total thyroidectomy with central neck dissection plus ipsilateral internal jugular node dissection (level II to IV) between January 2010 and December 2011. Of these patients, 51 had SLNM and 190 had multiple LNM (MLNM). The clinicopathologic characteristics of the two groups were compared.

Results: Age, gender ratio, and numbers of lateral neck nodes harvested (29.4±11.0 versus 30.3±9.5; P=0.574) were similar in the SLNM and MLNM groups. Mean primary tumor size was significantly smaller in the SLNM than in the MNLM group (1.03 cm versus 1.35 cm; P=0.037). The proportion of patients with primary tumor≤1 cm was significantly greater in the SLNM group (60.8% versus 38.4%; P=0.006), whereas the proportion with maximal node size≤0.7 cm (28.9% versus 73.3%; P<0.001) and the proportion with capsular invasion (62.7% versus 83.7%, P=0.002) were significantly lower in the SLNM than in the MLNM group.

Conclusions: Selective single level neck dissection can be considered as an alternative to systemic lateral neck dissection in PTC patients with SLNM, maximal metastatic node size≤0.7 cm, and no extrathyroidal invasion.

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Receiver operating characteristic (ROC) curve for maximal metastatic node size and capsular invasion in the prediction of solitary lateral neck metastasis.
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Figure 1: Receiver operating characteristic (ROC) curve for maximal metastatic node size and capsular invasion in the prediction of solitary lateral neck metastasis.

Mentions: Of the 241 patients, 51 (21.2%) had SLNM and 190 (78.8%) had MLNM. Table 2 shows the demographic and pathologic characteristics of the two groups. Mean primary tumors were significantly smaller in patients with SLNM than in patients with MLNM (1.03 ± 0.59 cm versus 1.35 ± 1.05 cm; P = 0.037). Of the 51 patients with SLNM, 31 (60.8%) had primary tumors ≤ 1 cm in size. Capsular invasion was significantly less frequent (62.7% versus 83.7%; P = 0.002), whereas skip LNMs were significantly more frequently II (39.2% versus 25.3%; P = 0.049), in the SLNM than in the MLNM group. The mean maximal size of metastatic nodes was lower in the SLNM than in the MLNM group (0.40 ± 0.38 cm versus 1.03 ± 0.60 cm; P < 0.001). Using a cutoff of 0.7 cm, the metastatic node size had a positive predictive value of 40.2% and a negative predictive value of 91.7% for predicting the presence of SLNM. This maximal metastatic node size had a specificity of 76.5% and a sensitivity of 69.4%. A receiver operating characteristics curve relating maximal metastatic node size and SLNM is shown in Figure 1. There were no significant differences in age, sex, multifocality, or bilaterality between the SLNM and MLNM groups, and the numbers of lateral neck nodes harvested per patient were similar in the two groups. Logistic regression analysis revealed that capsular invasion of primary tumor and maximal metastatic node size > 0.7 cm were independent predictors of MLNM (Table 3). The distribution of SLNM according to primary tumor location is shown in Table 4. The highest incidence of SLNM was at level III (52.9%). None of the patients with primary tumors in the lower pole had SLNMs at level II.


Solitary lateral neck node metastasis in papillary thyroid carcinoma.

Kim SM, Chun KW, Chang HJ, Kim BW, Lee YS, Chang HS, Park CS - World J Surg Oncol (2014)

Receiver operating characteristic (ROC) curve for maximal metastatic node size and capsular invasion in the prediction of solitary lateral neck metastasis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4016639&req=5

Figure 1: Receiver operating characteristic (ROC) curve for maximal metastatic node size and capsular invasion in the prediction of solitary lateral neck metastasis.
Mentions: Of the 241 patients, 51 (21.2%) had SLNM and 190 (78.8%) had MLNM. Table 2 shows the demographic and pathologic characteristics of the two groups. Mean primary tumors were significantly smaller in patients with SLNM than in patients with MLNM (1.03 ± 0.59 cm versus 1.35 ± 1.05 cm; P = 0.037). Of the 51 patients with SLNM, 31 (60.8%) had primary tumors ≤ 1 cm in size. Capsular invasion was significantly less frequent (62.7% versus 83.7%; P = 0.002), whereas skip LNMs were significantly more frequently II (39.2% versus 25.3%; P = 0.049), in the SLNM than in the MLNM group. The mean maximal size of metastatic nodes was lower in the SLNM than in the MLNM group (0.40 ± 0.38 cm versus 1.03 ± 0.60 cm; P < 0.001). Using a cutoff of 0.7 cm, the metastatic node size had a positive predictive value of 40.2% and a negative predictive value of 91.7% for predicting the presence of SLNM. This maximal metastatic node size had a specificity of 76.5% and a sensitivity of 69.4%. A receiver operating characteristics curve relating maximal metastatic node size and SLNM is shown in Figure 1. There were no significant differences in age, sex, multifocality, or bilaterality between the SLNM and MLNM groups, and the numbers of lateral neck nodes harvested per patient were similar in the two groups. Logistic regression analysis revealed that capsular invasion of primary tumor and maximal metastatic node size > 0.7 cm were independent predictors of MLNM (Table 3). The distribution of SLNM according to primary tumor location is shown in Table 4. The highest incidence of SLNM was at level III (52.9%). None of the patients with primary tumors in the lower pole had SLNMs at level II.

Bottom Line: The clinicopathologic characteristics of the two groups were compared.Mean primary tumor size was significantly smaller in the SLNM than in the MNLM group (1.03 cm versus 1.35 cm; P=0.037).The proportion of patients with primary tumor≤1 cm was significantly greater in the SLNM group (60.8% versus 38.4%; P=0.006), whereas the proportion with maximal node size≤0.7 cm (28.9% versus 73.3%; P<0.001) and the proportion with capsular invasion (62.7% versus 83.7%, P=0.002) were significantly lower in the SLNM than in the MLNM group.

View Article: PubMed Central - HTML - PubMed

Affiliation: Thyroid Cancer Center, Department of Surgery, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu 135-720, Seoul, Korea. SURGHSC@yuhs.ac.

ABSTRACT

Background: Papillary thyroid carcinoma (PTC) is associated with a high incidence of regional node metastasis, but the patterns of lateral neck node metastasis (LNM) vary. Occasionally, a solitary LNM (SLNM) is seen in PTC patients. We therefore assessed whether selective single level node dissection is appropriate in PTC patients with SLNM.

Methods: We retrospectively reviewed the medical records of 241 PTC patients who underwent total thyroidectomy with central neck dissection plus ipsilateral internal jugular node dissection (level II to IV) between January 2010 and December 2011. Of these patients, 51 had SLNM and 190 had multiple LNM (MLNM). The clinicopathologic characteristics of the two groups were compared.

Results: Age, gender ratio, and numbers of lateral neck nodes harvested (29.4±11.0 versus 30.3±9.5; P=0.574) were similar in the SLNM and MLNM groups. Mean primary tumor size was significantly smaller in the SLNM than in the MNLM group (1.03 cm versus 1.35 cm; P=0.037). The proportion of patients with primary tumor≤1 cm was significantly greater in the SLNM group (60.8% versus 38.4%; P=0.006), whereas the proportion with maximal node size≤0.7 cm (28.9% versus 73.3%; P<0.001) and the proportion with capsular invasion (62.7% versus 83.7%, P=0.002) were significantly lower in the SLNM than in the MLNM group.

Conclusions: Selective single level neck dissection can be considered as an alternative to systemic lateral neck dissection in PTC patients with SLNM, maximal metastatic node size≤0.7 cm, and no extrathyroidal invasion.

Show MeSH
Related in: MedlinePlus