Ann Surg Treat Res.  2015 Feb;88(2):63-68. 10.4174/astr.2015.88.2.63.

Predictive factors of central lymph node metastasis in papillary thyroid carcinoma

• Ahn BH
• Kim JR
• Jeong HC
• Lee JS
• Chang ES
• Kim YH

• KMID: 1804122
• DOI: http://doi.org/10.4174/astr.2015.88.2.63

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 (> or =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.

Keyword

Lymph node; Metastasis; Papillary thyroid cancer

MeSH Terms

Humans
Incidence
Lymph Nodes*
Neoplasm Metastasis*
Odds Ratio
Prospective Studies
Risk Factors
Thyroid Neoplasms*
Thyroidectomy

Figure

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  Fig. 1 Trend of central lymph node (CLN) metastasis in unilateral papillary thyroid cancer (PTC). CLND, central lymph node dissection.

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  Fig. 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.

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