Korean J Endocr Surg.  2015 Mar;15(1):10-14. 10.16956/kaes.2015.15.1.10.

Incidence and Predictive Factors of Central Neck Node Metastasis in Patients with T1, T2 Papillary Thyroid Cancer

• Bae KH
• Tae SY
• Ko BK
• Kim YS

• KMID: 2144008
• DOI: http://doi.org/10.16956/kaes.2015.15.1.10

Abstract

PURPOSE
Thyroidectomy without prophylactic central neck dissection may be recommended for small (T1 or T2) papillary thyroid carcinoma (PTC). The aim of this study was to determine the incidence and predictive factors of central cervical lymph node metastasis in T1/2 papillary thyroid carcinoma.
METHODS
A retrospective review of 877 patients with T1/2 PTC who underwent thyroidectomy and central lymph node dissection with or without lateral lymph node dissection from March 2007 to February 2014 was performed. The clinicopathologic results were reviewed and the incidence and predictive factors of central cervical lymph node metastasis (LNM) were analyzed.
RESULTS
The overall frequency of central LNM was 29.8%. In univariate analysis, male, younger age, bilaterality, multifocality, larger tumor size, lymphovascular invasion, and lateral lymph node metastasis were associated with central LNM. In multivariate analysis, younger age, larger tumor size, lymphovascular invasion, and lateral lymph node metastasis were independent variables of central LNM.
CONCLUSION
Central LNM is associated with younger age, larger tumor, lymphovascular invasion, and lateral lymph node metastasis in small (T1/2) PTC patients. Prophylactic central lymph node dissection should be considered in patients with risk factors.

Keyword

Papillary thyroid carcinoma; Thyroidectomy; Central lymph node metastasis

MeSH Terms

Humans
Incidence*
Lymph Node Excision
Lymph Nodes
Male
Multivariate Analysis
Neck Dissection
Neck*
Neoplasm Metastasis*
Retrospective Studies
Risk Factors
Thyroid Neoplasms*
Thyroidectomy

Reference

1. 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.

2. Gimm O, Rath FW, Dralle H. Pattern of lymph node metastases in papillary thyroid carcinoma. Br J Surg. 1998; 85:252–254.

3. Noguchi M, Kumaki T, Taniya T, Miyazaki I. Bilateral cervical lymph node metastases in well-differentiated thyroid cancer. Arch Surg. 1990; 125:804–806.

4. 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.

5. 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.

6. Tisell LE, Nilsson B, Mölne J, Hansson G, Fjälling M, Jansson S, et al. Improved survival of patients with papillary thyroid cancer after surgical microdissection. World J Surg. 1996; 20:854–859.

7. Carty SE, Cooper DS, Doherty GM, Duh QY, Kloos RT, Mandel SJ, et al. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid. 2009; 19:1153–1158.

8. Chen AY, Jemal A, Ward EM. Increasing incidence of differentiated thyroid cancer in the United States, 1988-2005. Cancer. 2009; 115:3801–3807.

9. Kilfoy BA, Zheng T, Holford TR, Han X, Ward MH, Sjodin A, et al. International patterns and trends in thyroid cancer incidence, 1973-2002. Cancer Causes Control. 2009; 20:525–531.

10. Lundgren CI, Hall P, Dickman PW, Zedenius J. Clinically significant prognostic factors for differentiated thyroid carcinoma: a population-based, nested case-control study. Cancer. 2006; 106:524–531.

11. Mercante G, Frasoldati A, Pedroni C, Formisano D, Renna L, Piana S, et al. Prognostic factors affecting neck lymph node recurrence and distant metastasis in papillary microcarcinoma of the thyroid: results of a study in 445 patients. Thyroid. 2009; 19:707–716.

12. McHenry CR, Rosen IB, Walfish PG. Prospective management of nodal metastases in differentiated thyroid cancer. Am J Surg. 1991; 162:353–356.

13. 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.

14. Hwang HS, Orloff LA. Efficacy of preoperative neck ultrasound in the detection of cervical lymph node metastasis from thyroid cancer. Laryngoscope. 2011; 121:487–491.

15. 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.

16. Mazzaferri EL, Doherty GM, Steward DL. The pros and cons of prophylactic central compartment lymph node dissection for papillary thyroid carcinoma. Thyroid. 2009; 19:683–689.

17. Yi KH, Park YJ, Koong SS, Kim JH, Na DG, Ryu JS, et al. Revised korean thyroid association management guidelines for patients with thyroid nodules and thyroid cancer. J Korean Soc Radiol. 2011; 64:389–416.

18. Zhou YL, Gao EL, Zhang W, Yang H, Guo GL, Zhang XH, et al. Factors predictive of papillary thyroid micro-carcinoma with bilateral involvement and central lymph node metastasis: a retrospective study. World J Surg Oncol. 2012; 10:67.

19. Henry JF, Gramatica L, Denizot A, Kvachenyuk A, Puccini M, Defechereux T. Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbecks Arch Surg. 1998; 383:167–169.

20. Palestini N, Borasi A, Cestino L, Freddi M, Odasso C, Robecchi A. Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer? Our experience. Langenbecks Arch Surg. 2008; 393:693–698.

21. Sywak M, Cornford L, Roach P, Stalberg P, Sidhu S, Delbridge L. Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery. 2006; 140:1000–1005.