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Predictive factors of central lymph node metastasis in papillary thyroid carcinoma.

Ahn BH, Kim JR, Jeong HC, Lee JS, Chang ES, Kim YH - Ann Surg Treat Res (2015)

Bottom Line: The rate of CLN metastasis was considerably higher in cases of younger patients (<45 years old) (P < 0.001; odds ratio [OR], 2.357) and of a maximal tumor size greater than 1 cm (P < 0.001; OR, 3.165).Younger age (<45 years old) and maximal tumor size greater than 1 cm were independent risk factors for CLN metastasis.Maximal tumor size greater than 1 cm and presence of ipsilateral CLN macrometastasis were independent risk factors for contralateral CLN metastasis.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Chungnam National University College of Medicine, Daejeon, Korea.

ABSTRACT

Purpose: The aim of this study was to evaluate the correlation between central lymph node (CLN) metastasis and clinicopathologic characteristics of papillary thyroid cancer (PTC). In addition, we investigated the incidence and risk factors for contralateral CLN metastasis in unilateral PTC. This study suggests the appropriate surgical extent for CLN dissection.

Methods: A prospective study of 500 patients with PTC who underwent total thyroidectomy and prophylactic bilateral CLN dissection was conducted.

Results: Of 500 patients, 255 had CLN metastases. The rate of CLN metastasis was considerably higher in cases of younger patients (<45 years old) (P < 0.001; odds ratio [OR], 2.357) and of a maximal tumor size greater than 1 cm (P < 0.001; OR, 3.165). Ipsilateral CLN metastasis was detected in 83.1% of cases (133/160) of unilateral PTC, only contralateral CLN metastases in 3.7% of cases (6/160), and bilateral CLN metastases in 13.1% of cases (21/160). The rate of contralateral CLN metastasis was considerably higher in cases of PTC with a large tumor size (≥1 cm) (P = 0.019; OR, 4.440) and with ipsilateral CLN metastasis (P = 0.047; OR, 2.613).

Conclusion: Younger age (<45 years old) and maximal tumor size greater than 1 cm were independent risk factors for CLN metastasis. Maximal tumor size greater than 1 cm and presence of ipsilateral CLN macrometastasis were independent risk factors for contralateral CLN metastasis. Therefore, both CLN dissections should be considered for unilateral PTC with a maximal tumor size greater than 1 cm or presence of ipsilateral CLN macrometastasis.

No MeSH data available.


Related in: MedlinePlus

Suggested scheme of decision making in unilateral papillary thyroid cancer (PTC). The ipsilateral central lymph node (CLN) metastasis could be evaluated by clinical examination or intraoperative pathology. CLND, CLN dissection.
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Figure 2: Suggested scheme of decision making in unilateral papillary thyroid cancer (PTC). The ipsilateral central lymph node (CLN) metastasis could be evaluated by clinical examination or intraoperative pathology. CLND, CLN dissection.

Mentions: We recommend that total thyroidectomy with simultaneous completion of contralateral CLND be performed in the presence of ipsilateral CLN macrometastasis in intraoperative frozensection pathology. This approach could limit unnecessary contralateral CLND for node-negative patients based on intraoperative pathological findings. According to the results of this study, both prophylactic CLND should be considered for unilateral PTC with a large tumor size (≥1 cm) or the presence of ipsilateral CLN macrometastasis. In contrast, prophylactic ipsilateral CLND has a satisfactory surgical extent for the initial operation in patients with PTC who have a small tumor and no ipsilateral CLN macrometastasis (Fig. 2).


Predictive factors of central lymph node metastasis in papillary thyroid carcinoma.

Ahn BH, Kim JR, Jeong HC, Lee JS, Chang ES, Kim YH - Ann Surg Treat Res (2015)

Suggested scheme of decision making in unilateral papillary thyroid cancer (PTC). The ipsilateral central lymph node (CLN) metastasis could be evaluated by clinical examination or intraoperative pathology. CLND, CLN dissection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4325652&req=5

Figure 2: Suggested scheme of decision making in unilateral papillary thyroid cancer (PTC). The ipsilateral central lymph node (CLN) metastasis could be evaluated by clinical examination or intraoperative pathology. CLND, CLN dissection.
Mentions: We recommend that total thyroidectomy with simultaneous completion of contralateral CLND be performed in the presence of ipsilateral CLN macrometastasis in intraoperative frozensection pathology. This approach could limit unnecessary contralateral CLND for node-negative patients based on intraoperative pathological findings. According to the results of this study, both prophylactic CLND should be considered for unilateral PTC with a large tumor size (≥1 cm) or the presence of ipsilateral CLN macrometastasis. In contrast, prophylactic ipsilateral CLND has a satisfactory surgical extent for the initial operation in patients with PTC who have a small tumor and no ipsilateral CLN macrometastasis (Fig. 2).

Bottom Line: The rate of CLN metastasis was considerably higher in cases of younger patients (<45 years old) (P < 0.001; odds ratio [OR], 2.357) and of a maximal tumor size greater than 1 cm (P < 0.001; OR, 3.165).Younger age (<45 years old) and maximal tumor size greater than 1 cm were independent risk factors for CLN metastasis.Maximal tumor size greater than 1 cm and presence of ipsilateral CLN macrometastasis were independent risk factors for contralateral CLN metastasis.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Chungnam National University College of Medicine, Daejeon, Korea.

ABSTRACT

Purpose: The aim of this study was to evaluate the correlation between central lymph node (CLN) metastasis and clinicopathologic characteristics of papillary thyroid cancer (PTC). In addition, we investigated the incidence and risk factors for contralateral CLN metastasis in unilateral PTC. This study suggests the appropriate surgical extent for CLN dissection.

Methods: A prospective study of 500 patients with PTC who underwent total thyroidectomy and prophylactic bilateral CLN dissection was conducted.

Results: Of 500 patients, 255 had CLN metastases. The rate of CLN metastasis was considerably higher in cases of younger patients (<45 years old) (P < 0.001; odds ratio [OR], 2.357) and of a maximal tumor size greater than 1 cm (P < 0.001; OR, 3.165). Ipsilateral CLN metastasis was detected in 83.1% of cases (133/160) of unilateral PTC, only contralateral CLN metastases in 3.7% of cases (6/160), and bilateral CLN metastases in 13.1% of cases (21/160). The rate of contralateral CLN metastasis was considerably higher in cases of PTC with a large tumor size (≥1 cm) (P = 0.019; OR, 4.440) and with ipsilateral CLN metastasis (P = 0.047; OR, 2.613).

Conclusion: Younger age (<45 years old) and maximal tumor size greater than 1 cm were independent risk factors for CLN metastasis. Maximal tumor size greater than 1 cm and presence of ipsilateral CLN macrometastasis were independent risk factors for contralateral CLN metastasis. Therefore, both CLN dissections should be considered for unilateral PTC with a maximal tumor size greater than 1 cm or presence of ipsilateral CLN macrometastasis.

No MeSH data available.


Related in: MedlinePlus