Top

Surgery Today

Published in:

01-02-2013 | Original Article

Pattern of initial metastasis in the cervical lymph node from papillary thyroid carcinoma

Authors: Naoyoshi Onoda, Tetsuro Ishikawa, Hidemi Kawajiri, Tsutomu Takashima, Kosei Hirakawa

Published in: Surgery Today | Issue 2/2013

Abstract

Purposes

This study attempted to reveal the pattern of initial lymphatic spread in order to investigate the clinical significances of lymph node metastasis in papillary thyroid carcinoma (PTC) since such information has yet to be elucidated in previous studies.

Methods

This study reviewed 501 consecutive patients with PTC who had been surgically treated, accompanied by routine node dissection of the central, and lateral compartments. Thirty-eight cases were found to have only one metastatic node, and 62 cases were found to have 2 or 3 metastatic nodes. The locations of these metastatic nodes were mapped, and evaluated.

Results

The initial lymph node metastasis occurred equally in the lateral and central compartments (19 vs. 19 nodes). Metastatic nodes were more frequently found in the central compartment (60 and 65 %) in cases with 2- and 3-node involvements. Twenty-two (60 %) and 33 (65 %) cases had at least one instance of lateral node involvement in those cases, respectively.

Conclusions

The current results demonstrated the pattern of initial lymphatic spread in PTC cases, and indicated the importance of evaluating the lateral nodes of at least compartments III and IV for accurate pathological staging, as well as for investigating the nature of the disease.

Grebe SK, Hay ID. Thyroid cancer nodal metastases: biologic significance and therapeutic considerations. Surg Oncol Clin N Am. 1996;5:43–63.PubMed

Noguchi S, Noguchi A, Murakami N. Papillary carcinoma of the thyroid II. Developing pattern of metastasis: value of prophylactic lymph node excision. Cancer. 1970;26:1061–4.PubMedCrossRef

Ito Y, Tsushima Y, Masuoka H, Yabuta T, Fukushima M, Inoue H, et al. Significance of prophylactic modified radical neck dissection for patients with low-risk papillary thyroid carcinoma measuring 1.1–3.0 cm: first report of a trial at Kuma Hospital. Surg Today. 2011;41:1486–91.PubMedCrossRef

Lundgren CI, Hall P, Dickman PW, Zedenius J. Clinically significant prognostic factors for differentiated thyroid carcinoma: a population-based, nested case-control study. Cancer. 2006;106:f524–31.CrossRef

Loh KC, Greenspan FS, Gee L, Miller TR, Yeo PP. Pathological tumor-node-metastasis (pTNM) staging for papillary and follicular thyroid carcinomas: a retrospective analysis of 700 patients. J Clin Endocrinol Metab. 1997;82:3553–62.PubMedCrossRef

Voutilainen PE, Multanen MM, Leppäniemi AK, Haglund CH, Haapiainen RK, Franssila KO. Prognosis after lymph node recurrence in papillary thyroid carcinoma depends on age. Thyroid. 2001;11:953–7.PubMedCrossRef

Grant CS, Stulak JM, Thompson GB, Richards ML, Reading CC, Hay ID. Risk and adequacy of an optimized surgical approach to the primary surgical management of papillary thyroid carcinoma treated during 1999–2006. World J Surg. 2010;34:1239–46.PubMedCrossRef

Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–214.PubMedCrossRef

Noguchi S, Murakami N, Yamashita H, Toda M, Kawamoto H. Papillary thyroid carcinoma. Modified radical neck resection improves prognosis. Arch Surg. 1998;133:276–80.PubMedCrossRef

10.

Machens A, Hinze R, Lautenschläger C, Thomusch O, Dralle H. Thyroid carcinoma invading the cervicovisceral axis: routes of invasion and clinical implications. Surgery. 2001;129:23–8.PubMedCrossRef

11.

Shaha AR. Revision thyroid surgery—technical considerations. Otolaryngol Clin North Am. 2008;41:1169–83, x.PubMedCrossRef

12.

Lefevre JH, Tresallet C, Leenhardt L, Jublanc C, Chigot JP, Menegaux F. Reoperative surgery for thyroid disease. Langenbecks Arch Surg. 2007;392:685–91.PubMedCrossRef

13.

Ito Y, Tomoda C, Uruno T, Takamura Y, Miya A, Kobayashi K, et al. Ultrasonographially and anatomopathologically detectable node metastasis in the lateral compartment as indicators of worse relapse-free survival in patients with papillary thyroid carcinoma. World J Surg. 2005;29:917–20.PubMedCrossRef

14.

Kupferman ME, Patterson DM, Mandel SJ, LiVolsi V, Weber RS. Safety of modified radical neck dissection for differentiated thyroid carcinoma. Laryngoscope. 2004;114:403–6.PubMedCrossRef

15.

Machens A, Hinze R, Thomusch O, Dralle H. Pattern of nodal metastasis for primary and reoperative thyroid cancer. World J Surg. 2002;26:22–8.PubMedCrossRef

16.

Machens A, Holzhausen HJ, Dralle H. Skip metastasis in thyroid cancer leaping the central lymph node compartment. Arch Surg. 2004;139:43–5.PubMedCrossRef

17.

Kupferman ME, Patterson M, Mandel SJ, LiVolsi V, Weber RS. Patterns of lateral neck metastasis in papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg. 2004;130:857–60.PubMedCrossRef

18.

Greene FL, Page DL, Fleming ID, editors. AJCC cancer staging manual. 6th ed. New York: Springer; 2002.

19.

Carty SE, Cooper DS, Doherty GM, Duh QY, Kloos RT, Mandel SJ, et al. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid. 2009;19:1153–8.PubMedCrossRef

20.

Uchino S, Noguchi S, Yamashita H, Watanabe S. Modified radical neck dissection for differentiated thyroid cancer: operative technique. World J Surg. 2004;28:1199–203.PubMedCrossRef

21.

Shigematsu N, Takami H, Kubo A. Unique treatment policy for well-differentiated thyroid cancer in Japan: results of a questionnaire distributed to members of Japanese Society of Thyroid Surgery and the International Association of Endocrine Surgeons. Endocr J. 2006;53:829–39.PubMedCrossRef

22.

Sugitani I, Fujimoto Y. Management of low-risk papillary thyroid carcinoma: unique conventional policy in Japan and our efforts to improve the level of evidence. Surg Today. 2010;40:199–215.PubMedCrossRef

23.

Rotstein L. The role of lymphadenectomy in the management of papillary carcinoma of the thyroid. J Surg Oncol. 2009;99:186–8.PubMedCrossRef

24.

Roh JL, Kim JM, Park CI. Lateral cervical lymph node metastases from papillary thyroid carcinoma: pattern of nodal metastases and optimal strategy for neck dissection. Ann Surg Oncol. 2008;15:1177–82.PubMedCrossRef

25.

Gimm O, Rath FW, Dralle H. Pattern of lymph node metastases in papillary thyroid carcinoma. Br J Surg. 1998;85:252–4.PubMedCrossRef

26.

Tsugawa K, Ohnishi I, Nakamura M, Miwa K, Yokoyama K, Michigishi T, et al. Intraoperative lymphatic mapping and sentinel lymph node biopsy in patients with papillary carcinoma of the thyroid gland. Biomed Pharmacother. 2002;56(Suppl 1):100s–3s.PubMedCrossRef

27.

Fukui Y, Yamakawa T, Taniki T, Numoto S, Miki H, Monden Y. Sentinel lymph node biopsy in patients with papillary thyroid carcinoma. Cancer. 2001;92:2868–74.PubMedCrossRef

28.

Roh JL, Park CI. Sentinel lymph node biopsy as guidance for central neck dissection in patients with papillary thyroid carcinoma. Cancer. 2008;113:1527–31.PubMedCrossRef

29.

Ito Y, Higashiyama T, Takamura Y, Miya A, Kobayashi K, Matsuzuka F, et al. Risk factors for recurrence to the lymph node in papillary thyroid carcinoma patients without preoperatively detectable lateral node metastasis: validity of prophylactic modified radical neck dissection. World J Surg. 2007;31:2085–91.PubMedCrossRef

30.

Bonnet S, Harti D, Leboulleux S, Baudin E, Lumbroso JD, Ghuzlan AA, et al. Prophylactic lymph node dissection for papillary thyroid cancer less than 2 cm: implications for radioiodine treatment. J Clin Endocrinol Metab. 2009;94:1162–7.PubMedCrossRef

31.

Xiao GZ, Gao L. Central lymph node metastasis: is it a reliable indicator of lateral node involvement in papillary thyroid carcinoma? World J Surg. 2010;34:237–41.PubMedCrossRef

32.

Bardet S, Malville E, Rame JP, Babin E, Samama G, De Raucourt D, et al. Macroscopic lymph-node involvement and neck dissection predict lymph-node recurrence in papillary thyroid carcinoma. Eur J Endocrinol. 2008;158:551–60.PubMedCrossRef

33.

Ito Y, Masuoka H, Fukushima M, Inoue H, Kihara M, Tomoda C, et al. Excellent prognosis of patients with solitary T1N0M0 papillary thyroid carcinoma who underwent thyroidectomy and elective lymph node dissection without radioiodine therapy. World J Surg. 2010;34:1285–90.PubMedCrossRef

34.

Kaczka K, Jakubiak-Wielganowicz M, Zawlik I, Ziolkowski R, Kuzdak K, Pomorski L. Nodal status in the papillary thyroid cancer. Comparison of the results of routine histopathological examination, immunohistochemistry and reverse transcription-polymerase chain reaction. Neoplasma. 2008;55:513–8.PubMed

Title: Pattern of initial metastasis in the cervical lymph node from papillary thyroid carcinoma
Authors: Naoyoshi Onoda
Tetsuro Ishikawa
Hidemi Kawajiri
Tsutomu Takashima
Kosei Hirakawa
Publication date: 01-02-2013
Publisher: Springer Japan
Published in: Surgery Today / Issue 2/2013
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-012-0228-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Pattern of initial metastasis in the cervical lymph node from papillary thyroid carcinoma

Abstract

Purposes

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purposes

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2013

Lung metastasis from an ovarian granulosa cell tumor 36 years after the initial diagnosis: report of a case

Nuclear factor κB activity correlates with the progression and prognosis of pancreatic cancer in a mouse model

Infraareolar access for thoracoscopic sympathectomy to treat primary hyperhidrosis

Evaluation of lymph node metastasis in patients with gastric cancer: a comparison of the directionality of lymph node metastasis and the total number of metastatic lymph nodes

Composite small cell and mucinous carcinoma originating from the intrahepatic bile duct: report of a case

The “tele” factor in surgery today and tomorrow: implications for surgical training and education