Top

World Journal of Surgery

Published in:

01-03-2019 | Original Scientific Report

Occult Contralateral Lateral Lymph Node Metastases in Unilateral N1b Papillary Thyroid Carcinoma

Authors: Hélène Bohec, Ingrid Breuskin, Julien Hadoux, Martin Schlumberger, Sophie Leboulleux, Dana M. Hartl

Published in: World Journal of Surgery | Issue 3/2019

Abstract

Objective

Therapeutic lateral neck dissection (ND) is recommended for N1b papillary thyroid carcinoma (PTC), while prophylactic contralateral lateral ND is not. Given the paucity of data, we investigated the frequency of and risk factors for occult lymph node metastases (LNM) in the contralateral lateral neck for N1b patients.

Patients and methods

This is a retrospective study conducted at a cancer center. Inclusion criteria were: unilateral PTC and ipsilateral lateral LNM confirmed by fine-needle aspiration biopsy. Patients with contralateral lateral LNM or bilateral tumor on ultrasound were excluded. All patients were treated with total thyroidectomy, bilateral central ND, ipsilateral therapeutic lateral ND and prophylactic contralateral ND of levels III–IV, followed by radioactive iodine.

Results

Sixty-three patients met the inclusion criteria. Occult contralateral lateral LNM were found in 23/63 patients (36.5%) who had more LNM in ispilateral (p = .01) and contralateral level VI (p < .0001), more frequent microscopic tumor in the contralateral lobe (p = .017) and a trend toward being at high risk (p = .06). Using receiver operating characteristic analysis, a cutoff of >4 LNM in ipsilateral level VI optimized sensitivity and specificity for predicting contralateral lateral LNM, with a sensitivity of 74%, specificity of 65%, positive predictive value of 55% and negative predictive value of 81%. Neck recurrence occurred in 14%, with only 1 patient recurring only in the contralateral lateral neck (1.5%).

Conclusion

Occult LNM in the contralateral lateral neck was found in 36.5% of patients. Five or more ipsilateral central LNM may aid in predicting contralateral lateral LNM, and high-risk patients may be more at risk. The clinical benefit of prophylactic contralateral lateral ND remains doubtful, however.

Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE et al (2015) American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26(1):1–133CrossRef

Carty SE, Cooper DS, Doherty GM, Duh Q-Y, Kloos RT, Mandel SJ et al (2009) Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid 19(11):1153–1158CrossRefPubMed

Robbins KT, Shaha AR, Medina JE, Califano JA, Wolf GT, Ferlito A et al (2008) Consensus statement on the classification and terminology of neck dissection. Arch Otolaryngol Head Neck Surg 134(5):536–538CrossRefPubMed

Tuttle RM, Tala H, Shah J, Leboeuf R, Ghossein R, Gonen M et al (2010) Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new American thyroid association staging system. Thyroid 20(12):1341–1349CrossRefPubMedPubMedCentral

Ito Y, Miyauchi A (2009) Prognostic factors and therapeutic strategies for differentiated carcinomas of the thyroid. Endocr J 56(2):177–192CrossRefPubMed

Ito Y, Kudo T, Kobayashi K, Miya A, Ichihara K, Miyauchi A (2012) Prognostic factors for recurrence of papillary thyroid carcinoma in the lymph nodes, lung, and bone: analysis of 5,768 patients with average 10-year follow-up. World J Surg 36(6):1274–1278. https://doi.org/10.1007/s00268-012-1423-5 CrossRefPubMed

Jeon MJ, Kim WG, Jang EK, Choi YM, Song DE, Sung TY et al (2015) Sub-classification of lateral cervical lymph node metastasis in papillary thyroid carcinoma by pathologic criteria. PLoS ONE 10(7):1–12

Sugitani I, Fujimoto Y, Yamada K, Yamamoto N (2008) Prospective outcomes of selective lymph node dissection for papillary thyroid carcinoma based on preoperative ultrasonography. World J Surg 32(11):2494–2502. https://doi.org/10.1007/s00268-008-9711-9 CrossRefPubMed

Wang LY, Palmer FL, Nixon IJ, Tuttle RM, Shah JP, Patel SG et al (2015) Lateral neck lymph node characteristics prognostic of outcome in patients with clinically evident N1b papillary thyroid cancer. Ann Surg Oncol 22(11):3530–3536CrossRefPubMedPubMedCentral

10.

Hughes DT, Miller BS, Cohen MS, Doherty GM, Gauger PG (2014) Outcomes of total thyroidectomy with therapeutic central and lateral neck dissection with a single dose of radioiodine in the treatment of regionally advanced papillary thyroid cancer and effects on serum thyroglobulin. Ann Surg Oncol 21(5):1647–1652CrossRefPubMed

11.

Lango M, Flieder D, Arrangoiz R, Veloski C, Yu JQ, Li T et al (2013) Extranodal extension of metastatic papillary thyroid carcinoma: correlation with biochemical endpoints, nodal persistence, and systemic disease progression. Thyroid 23(9):1099–1105CrossRefPubMedPubMedCentral

12.

McNamara WF, Wang LY, Palmer FL, Nixon IJ, Shah JP, Patel SG et al (2016) Pattern of neck recurrence after lateral neck dissection for cervical metastases in papillary thyroid cancer. Surgery 159(6):1565–1571CrossRefPubMed

13.

Chéreau N, Buffet C, Trésallet C, Tissier F, Leenhardt L, Menegaux F (2016) Recurrence of papillary thyroid carcinoma with lateral cervical node metastases: predictive factors and operative management. Surgery 159(3):755–762CrossRefPubMed

14.

Ito Y, Kudo T, Takamura Y, Kobayashi K, Miya A, Miyauchi A (2012) Lymph node recurrence in patients with N1b papillary thyroid carcinoma who underwent unilateral therapeutic modified radical neck dissection. World J Surg 36(3):593–597. https://doi.org/10.1007/s00268-011-1391-1 CrossRefPubMed

15.

Keum HS, Ji YB, Kim JM, Jeong JH, Choi WH, Ahn YH et al (2012) Optimal surgical extent of lateral and central neck dissection for papillary thyroid carcinoma located in one lobe with clinical lateral lymph node metastasis. World J Surg Oncol 10:221CrossRefPubMedPubMedCentral

16.

Société Française d’Oto-rhino-laryngologie et de Chirurgie de la Face et du Cou. Prise en charge ganglionnaire dans les cancers differenciés de souche folliculaire du corps thyroïdien chez l’adulte (2012)

Title: Occult Contralateral Lateral Lymph Node Metastases in Unilateral N1b Papillary Thyroid Carcinoma
Authors: Hélène Bohec
Ingrid Breuskin
Julien Hadoux
Martin Schlumberger
Sophie Leboulleux
Dana M. Hartl
Publication date: 01-03-2019
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 3/2019
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-018-4862-9

At a glance: The STEP trials

Springer Medicine

Occult Contralateral Lateral Lymph Node Metastases in Unilateral N1b Papillary Thyroid Carcinoma

Abstract

Objective

Patients and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Patients and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2019

Letter to the Editor: Early Consequences of Pectus Excavatum Surgery on Self-Esteem and General Quality of Life

Lung Adenocarcinoma has a Higher Risk of Lymph Node Metastasis than Squamous Cell Carcinoma: A Propensity Score-Matched Analysis

Soluble Urokinase Plasminogen Activator Receptor (suPAR) as an Added Predictor to Existing Preoperative Risk Assessments

Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018

Propensity-Matched Analysis Comparing Survival After Hybrid Thoracoscopic–Laparotomy Esophagectomy and Complete Thoracoscopic–Laparoscopic Esophagectomy

Rapid Relief: Thyroidectomy is a Quicker Cure than Radioactive Iodine Ablation (RAI) in Patients with Hyperthyroidism