Clin Exp Otorhinolaryngol.  2016 Mar;9(1):75-79. 10.21053/ceo.2016.9.1.75.

Metastatic Lymph Node Ratio of Central Neck Compartment Has Predictive Values for Locoregional Recurrence in Papillary Thyroid Microcarcinoma

• Choi SY
• Cho JK
• Moon JH
• Son YI

• KMID: 2166293
• DOI: http://doi.org/10.21053/ceo.2016.9.1.75

Abstract

OBJECTIVES
This study aimed to evaluate the significance of metastatic lymph node ratio (the ratio between the metastatic lymph node and the harvested lymph nodes; MLNR) in the central neck for the prediction of locoregional recurrence in patients with papillary thyroid microcarcinoma.
METHODS
After reviewing medical records of papillary thyroid microcarcinoma patients who received total thyroidectomy with central neck node dissection, 573 consecutive adult patients were enrolled in this study, with a follow-up period of more than 36 months. Regarding the risk of recurrence, multivariate analyses were performed with the following variables; sex, age, multiplicity of the primary tumor, presence of pathological extrathyroidal extension, the level of postoperative stimulated serum thyroglobulin, the number of harvested lymph nodes, the number of lymph node metastasis and MLNR.
RESULTS
The MLNR showed a predictive significance for the locoregional recurrence (P<0.05). Most recurrences were occurred in the lateral neck (n=12, 80%) with a median interval of 20 months. The lowest cutoff value of the MLNR for a meaningful separation of disease recurrence was 0.44 (hazard ratio, 8.86; 95% confidence interval, 1.49 to 52.58; P=0.001).
CONCLUSION
When the MLNR is higher than 0.44, there is an increased risk of locoregional recurrence mostly in the lateral neck. Therefore, MLNR of the central neck in a permanent or frozen biopsy may be helpful in decision making in the extent of thyroidectomy and/or the need for contralateral central neck lymph nodes dissection.

Keyword

Papillary Thyroid Microcarcinoma; Lymphatic Metastasis; Neck Dissection; Neoplasm Recurrence, Local; Tumor Burden

MeSH Terms

Adult
Biopsy
Decision Making
Follow-Up Studies
Humans
Lymph Nodes*
Lymphatic Metastasis
Medical Records
Multivariate Analysis
Neck Dissection
Neck*
Neoplasm Metastasis
Neoplasm Recurrence, Local
Recurrence*
Thyroglobulin
Thyroid Gland*
Thyroidectomy
Tumor Burden
Thyroglobulin

Reference

1. Ito Y, Jikuzono T, Higashiyama T, Asahi S, Tomoda C, Takamura Y, et al. Clinical significance of lymph node metastasis of thyroid papillary carcinoma located in one lobe. World J Surg. 2006; Oct. 30(10):1821–8.

2. 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; Feb. 106(3):524–31.

3. Podnos YD, Smith D, Wagman LD, Ellenhorn JD. The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer. Am Surg. 2005; Sep. 71(9):731–4.

4. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010; Jun. 17(6):1471–4.

5. 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; Mar. 237(3):399–407.

6. Stulak JM, Grant CS, Farley DR, Thompson GB, van Heerden JA, Hay ID, et al. Value of preoperative ultrasonography in the surgical management of initial and reoperative papillary thyroid cancer. Arch Surg. 2006; May. 141(5):489–94.

7. Kouvaraki MA, Shapiro SE, Fornage BD, Edeiken-Monro BS, Sherman SI, Vassilopoulou-Sellin R, et al. Role of preoperative ultrasonography in the surgical management of patients with thyroid cancer. Surgery. 2003; Dec. 134(6):946–54.

8. Noguchi S, Yamashita H, Uchino S, Watanabe S. Papillary microcarcinoma. World J Surg. 2008; May. 32(5):747–53.

9. 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; Sep. 393(5):693–8.

10. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009; Nov. 19(11):1167–214.

11. Wada N, Nakayama H, Suganuma N, Masudo Y, Rino Y, Masuda M, et al. Prognostic value of the sixth edition AJCC/UICC TNM classification for differentiated thyroid carcinoma with extrathyroid extension. J Clin Endocrinol Metab. 2007; Jan. 92(1):215–8.

12. Ito Y, Miyauchi A, Jikuzono T, Higashiyama T, Takamura Y, Miya A, et al. Risk factors contributing to a poor prognosis of papillary thyroid carcinoma: validity of UICC/AJCC TNM classification and stage grouping. World J Surg. 2007; Apr. 31(4):838–48.

13. Lee YS, Lim YS, Lee JC, Wang SG, Kim IJ, Lee BJ. Clinical implication of the number of central lymph node metastasis in papillary thyroid carcinoma: preliminary report. World J Surg. 2010; Nov. 34(11):2558–63.

14. Celen O, Yildirim E, Berberoglu U. Prognostic impact of positive lymph node ratio in gastric carcinoma. J Surg Oncol. 2007; Aug. 96(2):95–101.

15. Slidell MB, Chang DC, Cameron JL, Wolfgang C, Herman JM, Schulick RD, et al. Impact of total lymph node count and lymph node ratio on staging and survival after pancreatectomy for pancreatic adenocarcinoma: a large, population-based analysis. Ann Surg Oncol. 2008; Jan. 15(1):165–74.

16. Ceelen W, Van Nieuwenhove Y, Pattyn P. Prognostic value of the lymph node ratio in stage III colorectal cancer: a systematic review. Ann Surg Oncol. 2010; Nov. 17(11):2847–55.

17. Beal SH, Chen SL, Schneider PD, Martinez SR. An evaluation of lymph node yield and lymph node ratio in well-differentiated thyroid carcinoma. Am Surg. 2010; Jan. 76(1):28–32.

18. Lang BH, Wong KP, Wan KY, Lo CY. Significance of metastatic lymph node ratio on stimulated thyroglobulin levels in papillary thyroid carcinoma after prophylactic unilateral central neck dissection. Ann Surg Oncol. 2012; Apr. 19(4):1257–63.

19. Hay ID, Hutchinson ME, Gonzalez-Losada T, McIver B, Reinalda ME, Grant CS, et al. Papillary thyroid microcarcinoma: a study of 900 cases observed in a 60-year period. Surgery. 2008; Dec. 144(6):980–7.

20. Lee J, Song Y, Soh EY. Central lymph node metastasis is an important prognostic factor in patients with papillary thyroid microcarcinoma. J Korean Med Sci. 2014; Jan. 29(1):48–52.

21. Cho SY, Lee TH, Ku YH, Kim HI, Lee GH, Kim MJ. Central lymph node metastasis in papillary thyroid microcarcinoma can be stratified according to the number, the size of metastatic foci, and the presence of desmoplasia. Surgery. 2015; Jan. 157(1):111–8.

22. Schneider DF, Mazeh H, Chen H, Sippel RS. Lymph node ratio predicts recurrence in papillary thyroid cancer. Oncologist. 2013; 18(2):157–62.

23. Schneider DF, Chen H, Sippel RS. Impact of lymph node ratio on survival in papillary thyroid cancer. Ann Surg Oncol. 2013; Jun. 20(6):1906–11.

24. Chung YS, Kim JY, Bae JS, Song BJ, Kim JS, Jeon HM, et al. Lateral lymph node metastasis in papillary thyroid carcinoma: results of therapeutic lymph node dissection. Thyroid. 2009; Mar. 19(3):241–6.

25. Machens A, Hauptmann S, Dralle H. Lymph node dissection in the lateral neck for completion in central node-positive papillary thyroid cancer. Surgery. 2009; Feb. 145(2):176–81.