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World Journal of Surgery

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01-03-2018 | Surgical Symposium Contribution

Risk Factors for Central Neck Lymph Node Metastases in Micro- Versus Macro- Clinically Node Negative Papillary Thyroid Carcinoma

Authors: Luca Sessa, Celestino Pio Lombardi, Carmela De Crea, Serena Elisa Tempera, Rocco Bellantone, Marco Raffaelli

Published in: World Journal of Surgery | Issue 3/2018

Abstract

Background

Tumor size has been advocated as possible risk factors for occult central lymph node metastases (CNM) in papillary thyroid carcinoma (PTC) patients. This prospective study evaluated factors that could identify patients at higher risk of occult CNM, especially comparing micro-PTC and macro-PTC.

Methods

One hundred and eighty-six patients were recruited. All the patients had cN0 clinically unifocal PTC and underwent total thyroidectomy and bilateral prophylactic central neck dissection. Risk factors for occult CNM in micro- and macro-PTC patients were evaluated.

Results

Eighty-two patients showed CNM. The rate of CNM did not differ among different sizes cut off (≤20 mm, ≤10 mm, ≤5 mm P = NS). Significantly more pN1a than pN0 patients had pT3 tumors (35/82 vs. 26/104) (P < 0.05), extracapsular invasion (35/82 vs. 22/104) (P < 0.01) and microscopic multifocal disease (50/82 vs. 47/104) (P < 0.05). Independent risk factors for CNM were extracapsular invasion and multifocality at multivariate analysis. Risk factors for CNM in 77 micro-PTC were extracapsular invasion (16/31 pN1 vs. 10/46 pN0, P < 0.05) and multifocality (21/31 pN1 vs. 16/46 pN0, P < 0.01). Among 109 macro-PTC, risk factors for CNM were angioinvasion (15/51 pN1 vs. 7/58 pN0, P < 0.05) and classic PTC at the final histology (PTC vs. tall cell variant vs. follicular variant PTC) (P < 0.05).

Conclusions

Risk factors for CNM can differ between micro- and macro-PTC, but no preoperatively known clinical parameter is predictor of CNM in cN0 clinically unifocal PTC.

McLeod DS, Sawka AM, Cooper DS (2013) Controversies in primary treatment of low-risk papillary thyroid cancer. Lancet 381:1046–1057CrossRefPubMed

Shan CX, Zhang W, Jiang DZ et al (2012) Routine central neck dissection in differentiated thyroid carcinoma: a systematic review and meta-analysis. Laryngoscope 122:797–804CrossRefPubMed

Sancho JJ, Lennard TW, Paunovic I et al (2014) Prophylactic central neck dissection in papillary thyroid cancer: a consensus report of the European Society of Endocrine Surgeons (ESES). Langenbecks Arch Surg 399:155–163CrossRefPubMed

Shaha AR (2009) Prophylactic central compartment dissection in thyroid cancer: a new avenue of debate. Surgery 146:1224–1227CrossRefPubMed

Carling T, Long WD III, Udelsman R (2010) Controversy surrounding the role for routine central lymph node dissection for differentiated thyroid cancer. Curr Opin Oncol 22:30–34CrossRefPubMed

McHenry CR (2011) Prophylactic central compartment neck dissection for papillary thyroid cancer: the search for justification continues. Surgery 150:1058–1060CrossRefPubMed

Cisco RM, Shen WT, Gosnell JE (2012) Extent of surgery for papillary thyroid cancer: preoperative imaging and role of prophylactic and therapeutic neck dissection. Curr Treat Options Oncol 13:1–10CrossRefPubMed

Shen WT, Ogawa L, Ruan D et al (2010) Central neck lymph node dissection for papillary thyroid cancer: the reliability of surgeon judgment in predicting which patients will benefit. Surgery 148:398–403CrossRefPubMed

Ji YB, Lee DW, Song CM et al (2014) Accuracy of intraoperative determination of central node metastasis by the surgeon in papillary thyroid carcinoma. Otolaryngol Head Neck Surg 150:542–547CrossRefPubMed

10.

Park JP, Roh JL, Lee JH et al (2014) Risk factors for central neck lymph node metastasis of clinically noninvasive, node-negative papillary thyroid microcarcinoma. Am J Surg 3:412–418CrossRef

11.

Ito Y, Fukushima M, Higashiyama T et al (2013) Tumor size is the strongest predictor of microscopic lymph node metastasis and lymph node recurrence of N0 papillary thyroid carcinoma. Endocr J 60:113–117CrossRefPubMed

12.

Wang W, Gu J, Shang J, Wang K (2013) Correlation analysis on central lymph node metastasis in 276 patients with cN0 papillary thyroid carcinoma. Int J Clin Exp Pathol 6:510–515PubMedPubMedCentral

13.

Blanchard C, Brient C, Volteau C et al (2013) Factors predictive of lymph node metastasis in the follicular variant of papillary thyroid carcinoma. Br J Surg 100:1312–1317CrossRefPubMed

14.

Perros P, Colley S, Boelaert K et al (2014) Guidelines for the management of thyroid cancer. Clin Endocriniol (Oxf) 81(Suppl 1):1–122

15.

National Comprehensive Cancer Network (2010) NCCN clinical practice guidelines in oncology. Thyroid carcinoma; http://www.nccn.org/professionals/physician_gls/PDF/thyroid/pdf

16.

White ML, Gauger PG, Doherty GM (2007) Central lymph node dissection in differentiated thyroid cancer. World J Surg 31:895–904. https://doi.org/10.1007/s00268-006-0907-6 CrossRefPubMed

17.

Barczynski M, Konturek A, Stopa M et al (2013) Prophylactic central neck dissection for papillary thyroid cancer. Br J Surg 100:410–418CrossRefPubMed

18.

Giordano D, Valcavi R, Thompson GB et al (2012) Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid 22:911–917CrossRefPubMed

19.

Koo BS, Choi EC, Yoon YH et al (2009) Predictive factors for ipsilateral or contralateral central lymph node metastasis in unilateral papillary thyroid carcinoma. Ann Surg 249:840–844CrossRefPubMed

20.

Raffaelli M, De Crea C, Sessa L et al (2012) Prospective evaluation of total thyroidectomy versus ipsilateral versus bilateral central neck dissection in patients with clinically node negative papillary thyroid carcinoma. Surgery 152:957–964CrossRefPubMed

21.

American Joint Committee on Cancer. Thyroid. (2010) AJCC cancer staging manual, 7th edn. Springer, New York, pp 87–92CrossRef

22.

Carty SE, Cooper DS, Doherty GM et al (2009) Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid 19:1153–1158CrossRefPubMed

23.

Lombardi CP, Bellantone R, De Crea C et al (2010) Papillary thyroid microcarcinoma: extrathyroidal extension, lymph node metastases, and risk factors for recurrence in a high prevalence of goiter area. World J Surg 34:1214–1221. https://doi.org/10.1007/s00268-009-0375-x CrossRefPubMed

24.

Cappelli C, Castellano M, Braga M et al (2007) Aggressiveness and outcome of papillary thyroid carcinoma (PTC) versus microcarcinoma (PMC): a mono-institutional experience. J Surg Oncol 95:555–560CrossRefPubMed

25.

Raffaelli M, De Crea C, Sessa L et al (2013) Can intraoperative frozen section influence the extension of central neck dissection in cN0 papillary thyroid carcinoma? Langenbecks Arch Surg 398:383–388CrossRefPubMed

26.

Bellantone R, Lombardi CP, Boscherini M et al (1998) Prognostic factors in differentiated thyroid carcinoma: a multivariate analysis of 234 consecutive patients. J Surg Oncol 68:237–241CrossRefPubMed

27.

Sippel RS, Chen H (2009) Controversies in the surgical management of newly diagnosed and recurrent/residual thyroid cancer. Thyroid 19:1373–1380CrossRefPubMed

28.

Viola D, Materazzi G, Valerio L et al (2015) Prophylactic central compartment lymph node dissection in papillary thyroid carcinoma: clinical implications derived from the first prospective randomized controlled single institution study. J Clin Endocrinol Metab 100:1316–1324CrossRefPubMed

29.

Raffaelli M, De Crea C, Sessa L et al (2015) Ipsilateral central neck dissection plus frozen section examination versus prophylactic bilateral central neck dissection in cN0 papillary thyroid carcinoma. Ann Surg Oncol 22:2302–2308CrossRefPubMed

30.

Finnerty BM, Kleiman DA, Scognamiglio T et al (2015) Navigating the management of follicular variant papillary thyroid carcinoma subtypes: a classic PTC comparison. Ann Surg Oncol 22:1200–1206CrossRefPubMed

31.

Lu J, Gao J, Zhang J et al (2015) Association between BRAF V600E mutation and regional lymph node metastases in papillary thyroid carcinoma. Int J Clin Exp Pathol 8:793–799PubMedPubMedCentral

32.

Henkle LE, Pfeifer JD, Ma C et al (2015) BRAF mutation is not predictive of long-term outcome in papillary thyroid carcinoma. Cancer Med 4:791–799CrossRef

33.

Gouveia C, Can NT, Bostrom A et al (2013) Lack of association of BRAF mutation with negative prognostic indicators in papillary thyroid carcinoma: the University of California, San Francisco, experience. JAMA Otolaryngol Head Neck Surg 139:1164–1170CrossRefPubMed

Title: Risk Factors for Central Neck Lymph Node Metastases in Micro- Versus Macro- Clinically Node Negative Papillary Thyroid Carcinoma
Authors: Luca Sessa
Celestino Pio Lombardi
Carmela De Crea
Serena Elisa Tempera
Rocco Bellantone
Marco Raffaelli
Publication date: 01-03-2018
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 3/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-017-4390-z

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Risk Factors for Central Neck Lymph Node Metastases in Micro- Versus Macro- Clinically Node Negative Papillary Thyroid Carcinoma

Abstract

Background

Methods

Results

Conclusions

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Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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