J Korean Surg Soc.  2010 Feb;78(2):82-86. 10.4174/jkss.2010.78.2.82.

Risk Factors of Lymph Node Metastasis in Papillary Thyroid Microcarcinoma

• Lee NS
• Bae JS
• Jeong SR
• Jung CK
• Lim DJ
• Park WC
• Kim JS
• Kim SN

• KMID: 2096559
• DOI: http://doi.org/10.4174/jkss.2010.78.2.82

Abstract

PURPOSE
Despite the overall excellent prognosis for patients with papillary thyroid microcarcinoma (PTMC), these tumors are also associated with a 5% relatively high lymph node (LN) recurrence rate and the optimal surgical extent of papillary thyroid microcarcinoma has been controversial. Cervical LN metastases (LNMs) are found in about 40~65% of patients with PTMC. The aim of this study is to identify the factors affecting lymph node metastases (LNMs) in patients with PTMC.
METHODS
We performed a retrospective study of 335 patients with PTMC who underwent total thyroidectomy or lobectomy with elective central lymph node dissection (CLND) at Kangnam St. Mary's Hospital between Jan. 2006 and Dec. 2008. We investigated the association of LNMs and clinicopathologic factors such as sex, age, multiplicity, extrathyroidal extension, and tumor size.
RESULTS
LNMs were present in 88 patients (26.3%). Univariate analysis showed that less than 45 years of age, male, multiplicity, a tumor size of greater than 5 mm, thyroid capsular invasion and extrathyroidal extension were predictive factors for LNMs (P<0.05). Of these, the age, male, tumor size and extrathyroidal extension were independent predictive factors for LNMs on multivariate analysis.
CONCLUSION
A tumor size (>5 mm), male, age (<45) and extrathyroidal extension were determined as the predictive factors for LNMs, which occurred in about one fourth of the patients with PTMC. Therefore, elective CLND should be considered in patients with PTMC who have these factors through a thorough investigation before surgery.

Keyword

Papillary thyroid microcarcinoma; Central lymph node metastasis

MeSH Terms

Carcinoma, Papillary
Humans
Lymph Node Excision
Lymph Nodes
Male
Neoplasm Metastasis
Prognosis
Recurrence
Retrospective Studies
Risk Factors
Thyroid Gland
Thyroid Neoplasms
Thyroidectomy
Carcinoma, Papillary
Thyroid Neoplasms

Reference

1. Yokozawa T, Miyauchi A, Kuma K, Sugawara M. Accurate and simple method of diagnosing thyroid nodules the modified technique of ultrasound-guided fine needle aspiration biopsy. Thyroid. 1995. 5:141–145.

2. Hedinger C, Williams ED, Sobin LH. The WHO histological classification of thyroid tumors: a commentary on the second edition. Cancer. 1989. 63:908–911.

3. Yoo YS, Kim SS, Mun SP, Kim KJ, Chang JH, Min YD, et al. Clinicopathologic findings of micropapillary carcinomas, according to tumor size. J Korean Surg Soc. 2009. 76:348–354.

4. Kim JH, Yang JH. Papillary microcarcinoma of the thyroid. J Korean Surg Soc. 2001. 61:485–490.

5. Lee KJ, Kim HR, Kim SJ, Lee SC, Kim JG, Sung GY, et al. Analysis of the relationship between central cervical lymph node metastasis from papillary thyroid carcinoma and the associated factors according to the tumor size. J Korean Surg Soc. 2008. 75:156–161.

6. Ito Y, Tomoda C, Uruno T, Takamura Y, Miya A, Kobayashi K, et al. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid. World J Surg. 2006. 30:91–99.

7. Chow SM, Law SC, Chan JK, Au SK, Yau S, Lau WH. Papillary microcarcinoma of the thyroid-Prognostic significance of lymph node metastasis and multifocality. Cancer. 2003. 98:31–40.

8. 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. 237:399–407.

9. Shindo M, Wu JC, Park EE, Tanzella F. The importance of central compartment elective lymph node excision in the staging and treatment of papillary thyroid cancer. Arch Otolaryngol Head Neck Surg. 2006. 132:650–654.

10. 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. 19:1167–1214.

11. Yamamoto Y, Maeda T, Izumi K, Otsuka H. Occult papillary carcinoma of the thyroid. A study of 408 autopsy cases. Cancer. 1990. 65:1173–1179.

12. Harach HR, Franssila KO, Wasenius VM. Occult papillary carcinoma of the thyroid. A "normal" finding in Finland. A systematic autopsy study. Cancer. 1985. 56:531–538.

13. Shaha AR, Tuttle RM, Shah JP. Papillary microcarcinoma of the thyroid. J Surg Oncol. 2007. 95:532–533.

14. Appetecchia M, Scarcello G, Pucci E, Procaccini A. Outcome after treatment of papillary thyroid microcarcinoma. J Exp Clin Cancer Res. 2002. 21:159–164.

15. Sakorafas GH, Giotakis J, Stafyla V. Papillary thyroid microcarcinoma: a surgical perspective. Cancer Treat Rev. 2005. 31:423–438.

16. Hay ID, Grant CS, van Heerden JA, Goellner JR, Ebersold JR, Bergstralh EJ. Papillary thyroid microcarcinoma: a study of 535 cases observed in a 50-year period. Surgery. 1992. 112:1139–1146. discussion 46-7.

17. Harwood J, Clark OH, Dunphy JE. Significance of lymph node metastasis in differentiated thyroid cancer. Am J Surg. 1978. 136:107–112.

18. Ozaki O, Ito K, Kobayashi K, Suzuki A, Manabe Y. Modified neck dissection for patients with nonadvanced, differentiated carcinoma of the thyroid. World J Surg. 1988. 12:825–829.

19. Sampson RJ, Oka H, Key CR, Buncher CR, Iijima S. Metastases from occult thyroid carcinoma. An autopsy study from Hiroshima and Nagasaki, Japan. Cancer. 1970. 25:803–811.

20. Kasai N, Sakamoto A. New subgrouping of small thyroid carcinomas. Cancer. 1987. 60:1767–1770.

21. Roh JL, Kim JM, Park CI. Central cervical nodal metastasis from papillary thyroid microcarcinoma: pattern and factors predictive of nodal metastasis. Ann Surg Oncol. 2008. 15:2482–2486.

22. Besic N, Zgajnar J, Hocevar M, Petric R. Extent of thyroidectomy and lymphadenectomy in 254 patients with papillary thyroid microcarcinoma: a single-institution experience. Ann Surg Oncol. 2009. 16:920–928.

23. Cady B, Sedgwick CE, Meissner WA, Wool MS, Salzman FA, Werber J. Risk factor analysis in differentiated thyroid cancer. Cancer. 1979. 43:810–820.

24. Scheumann GF, Gimm O, Wegener G, Hundeshagen H, Dralle H. Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer. World J Surg. 1994. 18:559–567.

25. Gulben K, Berberoglu U, Celen O, Mersin HH. Incidental papillary microcarcinoma of the thyroid--factors affecting lymph node metastasis. Langenbecks Arch Surg. 2008. 393:25–29.

26. Lee SH, Lee SS, Jin SM, Kim JH, Rho YS. Predictive factors for central compartment lymph node metastasis in thyroid papillary microcarcinoma. Laryngoscope. 2008. 118:659–662.

27. Sugg SL, Ezzat S, Rosen IB, Freeman JL, Asa SL. Distinct multiple RET/PTC gene rearrangements in multifocal papillary thyroid neoplasia. J Clin Endocrinol Metab. 1998. 83:4116–4122.