J Korean Thyroid Assoc.  2012 Nov;5(2):109-113. 10.11106/jkta.2012.5.2.109.

N Stage: Controversies and Recent Issues

Affiliations
  • 1Department of Pathology, Seoul National University College of Medicine, Seoul, Korea. lilloa@snuh.org

Abstract

The current TNM staging including N staging has been suggested as a gold standard for the appropriate therapy in the well differentiated thyroid cancer patients. N staging was established based on histopathologic findings, however, the newly suggested prognostic factors for the revision of N staging include some clinicopathologic factors, such as clinical metastasis (macrometastasis), large node metastasis (> or =3 cm), extranodal extension and the number of metastatic node. Recently, American Thyroid Association reported the possibility that the low-risk group patients would be overestimated as high-risk group patients that leads to the overtreatment, the following unnecessary complication and the economic cost. The preexisting N1a/N1b classification by anatomical location of metastatic node still remains as a strong prognostic factor; however, many evidences indicated that the clinicopathologic factors described above should be considered in the risk stratification in the near future. Thus, it needs to be stressed that the four factors of micrometastasis, large node metastasis (> or =3 cm), gross or microscopic extranodal extension and multiple metastatic node (>5 cm) have been established as negative or positive prognostic factors and should be noted in clinical practice.

Keyword

Well differentiated thyroid carcinoma; TNM staging; N staging; Nodal metastasis

MeSH Terms

Humans
Neoplasm Metastasis
Neoplasm Micrometastasis
Neoplasm Staging
Thyroid Gland
Thyroid Neoplasms

Reference

1. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A 3rd. AJCC cancer staging manual. 2010. 7th ed. Chicago: American Joint Committee on Cancer.
2. Lang BH, Lo CY, Chan WF, Lam KY, Wan KY. Staging systems for papillary thyroid carcinoma: a review and comparison. Ann Surg. 2007. 245(3):366–378.
3. Clark OH. Thyroid cancer and lymph node metastases. J Surg Oncol. 2011. 103(6):615–618.
Article
4. Wada N, Duh QY, Sugino K, Iwasaki H, Kameyama K, Mimura T, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg. 2003. 237(3):399–407.
5. Baloch ZW, LiVolsi VA. Prognostic factors in well-differentiated follicular-derived carcinoma and medullary thyroid carcinoma. Thyroid. 2001. 11(7):637–645.
Article
6. Sakorafas GH, Giotakis J, Stafyla V. Papillary thyroid microcarcinoma: a surgical perspective. Cancer Treat Rev. 2005. 31(6):423–438.
Article
7. Zaydfudim V, Feurer ID, Griffin MR, Phay JE. The impact of lymph node involvement on survival in patients with papillary and follicular thyroid carcinoma. Surgery. 2008. 144(6):1070–1077.
Article
8. Sakorafas GH, Sampanis D, Safioleas M. Cervical lymph node dissection in papillary thyroid cancer: current trends, persisting controversies, and unclarified uncertainties. Surg Oncol. 2010. 19(2):e57–e70.
Article
9. Toniato A, Boschin I, Casara D, Mazzarotto R, Rubello D, Pelizzo M. Papillary thyroid carcinoma: factors influencing recurrence and survival. Ann Surg Oncol. 2008. 15(5):1518–1522.
Article
10. Randolph G, Duh QY, Heller KS, Livolsi VA, Mandel SJ, Steward D, et al. The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension ATA Surgical Affairs Committee's taskforce on thyroid cancer nodal surgery. Thyroid. 2012. [Epub ahead of print].
Article
11. Cranshaw IM, Carnaille B. Micrometastases in thyroid cancer. An important finding? Surg Oncol. 2008. 17(3):253–258.
Article
12. Leon X, Sancho FJ, Garcia J, Sanudo JR, Orus C, Quer M. Incidence and significance of clinically unsuspected thyroid tissue in lymph nodes found during neck dissection in head and neck carcinoma patients. Laryngoscope. 2005. 115(3):470–474.
Article
13. Qubain SW, Nakano S, Baba M, Takao S, Aikou T. Distribution of lymph node micrometastasis in pN0 welldifferentiated thyroid carcinoma. Surgery. 2002. 131(3):249–256.
Article
14. Ito Y, Miyauchi A. Prognostic factors of papillary and follicular carcinomas in Japan based on data of kuma hospital. J Thyroid Res. 2012. 2012:973497.
Article
15. Ito Y, Kudo T, Kobayashi K, Miya A, Ichihara K, Miyauchi A. 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. 2012. 36(6):1274–1278.
Article
16. Ito Y, Fukushima M, Tomoda C, Inoue H, Kihara M, Higashiyama T, et al. Prognosis of patients with papillary thyroid carcinoma having clinically apparent metastasis to the lateral compartment. Endocr J. 2009. 56(6):759–766.
Article
17. Sugitani I, Kasai N, Fujimoto Y, Yanagisawa A. A novel classification system for patients with PTC: addition of the new variables of large (3 cm or greater) nodal metastases and reclassification during the follow-up period. Surgery. 2004. 135(2):139–148.
Article
18. Ricarte-Filho J, Ganly I, Rivera M, Katabi N, Fu W, Shaha A, et al. Papillary thyroid carcinomas with cervical lymph node metastases can be stratified into clinically relevant prognostic categories using oncogenic BRAF, the number of nodal metastases, and extra-nodal extension. Thyroid. 2012. 22(6):575–584.
Article
19. Ferlito A, Rinaldo A, Devaney KO, MacLennan K, Myers JN, Petruzzelli GJ, et al. Prognostic significance of microscopic and macroscopic extracapsular spread from metastatic tumor in the cervical lymph nodes. Oral Oncol. 2002. 38(8):747–751.
Article
20. Ito Y, Hirokawa M, Jikuzono T, Higashiyama T, Takamura Y, Miya A, et al. Extranodal tumor extension to adjacent organs predicts a worse cause-specific survival in patients with papillary thyroid carcinoma. World J Surg. 2007. 31(6):1194–1201.
Article
21. Leboulleux S, Rubino C, Baudin E, Caillou B, Hartl DM, Bidart JM, et al. Prognostic factors for persistent or recurrent disease of papillary thyroid carcinoma with neck lymph node metastases and/or tumor extension beyond the thyroid capsule at initial diagnosis. J Clin Endocrinol Metab. 2005. 90(10):5723–5729.
Article
22. Smith VA, Sessions RB, Lentsch EJ. Cervical lymph node metastasis and papillary thyroid carcinoma: does the compartment involved affect survival? Experience from the SEER database. J Surg Oncol. 2012. 106(4):357–362.
Article
Full Text Links
  • JKTA
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr