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Open Access 01-04-2012 | Endocrine Tumors

Significance of Metastatic Lymph Node Ratio on Stimulated Thyroglobulin Levels in Papillary Thyroid Carcinoma after Prophylactic Unilateral Central Neck Dissection

Authors: Brian Hung-Hin Lang, MS, FRACS, Kai Pun Wong, MBBS, MRCS, Koon Yat Wan, MBBS, FRCR, Chung-Yau Lo, MS, FRCS, FACS

Published in: Annals of Surgical Oncology | Issue 4/2012

Abstract

Background

Prognostic significance of metastatic central lymph node ratio (CLNR) in papillary thyroid carcinoma (PTC) remains unknown. Because postsurgical detectable stimulated thyroglobulin (DsTg) after radioiodine ablation may imply persistent or recurrent disease, we evaluated the association between CLNR and rate of DsTg in patients with PTC who underwent unilateral prophylactic central neck dissection.

Methods

To be eligible for analysis, the prophylactic central neck dissection specimen had to contain ≥3 central lymph nodes (CLNs) with ≥1 harboring metastasis. Of 129 specimens, 51 (39.5%) were eligible. CLNR was calculated as follows: (number of metastatic CLNs/number of CLNs retrieved) × 100. They were categorized into group 1 (CLNR <33.34%) (n = 14), group 2 (CLNR 33.34–66.67%) (n = 15), and group 3 (CLNR >66.67%) (n = 22). Postablation sTg level was measured 6 months after radioiodine ablation. A multivariate analysis was conducted to identify factors for postablation DsTg.

Results

Young age, palpable neck swelling, large tumor size, advanced tumor, node, metastasis system (TNM) stage, and large number of metastatic CLNs were significantly associated with high CLNR (P < 0.05). Compared to groups 1 and 2, group 3 had significantly higher DsTg rate (P = 0.018). Those who developed subsequent recurrence had significantly higher DsTg rate than those who did not (100% vs. 39.1%, P = 0.013). In the multivariate analysis for postablative DsTg, after adjusting for age, palpable neck swelling, tumor size, TNM stage, and number of metastatic CLNs, CLNR was the only independent factor (odds ratio 1.15, 95% confidence interval 1.01–1.31, P = 0.036).

Conclusions

A higher CLNR was associated with a higher rate of postablative DsTg; this may imply higher future recurrence rate.

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Title: Significance of Metastatic Lymph Node Ratio on Stimulated Thyroglobulin Levels in Papillary Thyroid Carcinoma after Prophylactic Unilateral Central Neck Dissection
Authors: Brian Hung-Hin Lang, MS, FRACS
Kai Pun Wong, MBBS, MRCS
Koon Yat Wan, MBBS, FRCR
Chung-Yau Lo, MS, FRCS, FACS
Publication date: 01-04-2012
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 4/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-011-2105-5

At a glance: The STEP trials

Springer Medicine

Significance of Metastatic Lymph Node Ratio on Stimulated Thyroglobulin Levels in Papillary Thyroid Carcinoma after Prophylactic Unilateral Central Neck Dissection

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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