Pattern of and Factors Related with Central Compartment Lymph Node Metastasis in Papillary Thyroid Carcinoma

Lee, Byung Joo; Wang, Soo Geun; Lee, Jin Choon; Kim, Dae Hee; Son, Seok Man; Kim, In Ju; Kim, Yong Ki

Abstract

BACKGROUND AND OBJECTIVES
The incidence of lymph node metastasis in patients with papillary thyroid carcinoma (PTC) has been reported to be 35-80%. Although lymph node metastasis in cases with PTC was not considered to be a significant prognostic indicator, several recent reporters have demonstrated that nodal metastasis increase locoregional recurrence and decrease survival rate. Although the prophylactic neck dissection of central compartment is still controversial, morbidity after re-operation in central compartment lymph nodes is significantly associated. Therefore, to determine the means of limiting lymph node dissection, we attempted to determine the factors related with central compartment lymph node metastasis and evaluate the pattern of it's metastasis in patients with PTC.
SUBJECTS AND METHOD
We undertook a retrospective study of 210 patients treated between March, 2002 and April, 2006 for papillary thyroid carcinoma by total thyroidectomy and central compartment neck dissection (n=210) with or without comprehensive lateral neck dissection. There were 179 women and 31 men whose mean age was 48.3 years old. Following criteria were used to study the pattern of and factors related with central compartment lymph node metastasis : age (>40), sex, the involvement of lateral neck lymph node, tumor size, multifocality of tumors, extracapsular extension of tumors, presence of tumor emboli in lymphovascular space of tumors.
RESULTS
In 134 of 152 patients (63.8%), central compartment lymph node metastasis were found. Of those factors, the involvement of lateral neck lymph node (p<0.001), extracapsular extension of tumors (p=0.013), more than 1 cm or 2 cm in primary tumor size (p=0.002, p<0.001, respectively) were significant related factors for central compartment lymph node metastasis. Age, sex, multifocality of tumors, the presence of tumor emboli in lymphovascular space of tumors were not significantly related with central compartment lymph node metastasis. Sixty-two (46.3%) of 134 patients with central compartment lymph node metastasis had contralateral lymph node metastasis. The incidence of contralateral lymph node metastasis was not related with these factors.
CONCLUSION
Prophylactic neck dissection of cental compartment should be recommended as a routine procedure in all patients and particularly in patients with the metastatic lymph nodes in the lateral neck, extracapsular extension of tumors, and more than 1cm in tumor size.