Yonsei Med J.  2012 Sep;53(5):924-930.

Impact of Clinicopathologic Factors on Subclinical Central Lymph Node Metastasis in Papillary Thyroid Microcarcinoma

• Kim BY
• Jung CH
• Kim JW
• Lee SW
• Kim CH
• Kang SK
• Mok JO

Abstract

PURPOSE
We evaluated whether the clinicopathological factors of papillary thyroid microcarcinoma (PTMC), especially tumoe size, are associated with subcinical central lymph node metastasis.
MATERIALS AND METHODS
A total of 160 patients diagnosed with PTMC who underwent total thyroidectomy with bilateral central lymph node dissection were enrolled in this study. All patients were clinically lymph node negative PTMC. Patients were divided into 2 groups according to the size of tumor (< or =5 mm vs. >5 mm). Clinicopathologic risk factors for subclinical central lymph node metastasis were analyzed.
RESULTS
Subclinical central lymph node metastasis was detected in 61 (38.1%). Patients with tumors < or =5 mm had a lower frequency of extrathyroidal extension, multifocality and subclinical central lymph node metastasis. On multivariate analysis, only male and tumor size >5 mm were independent predictors of subclinical central lymph node metastasis; age, multifocality, bilaterality, extrathyroidal extension, lymphvascular invasion and lymphocytic thyroiditis were not.
CONCLUSION
In this study, male and tumor size >5 mm were two independent predictive factors for subclinical central lymph node metastasis in PTMC. These are easier factors to assess before surgery than other factors when planning the central lymph node dissection. However, further long-term follow-up studies are needed to confirm the prognostic significance of subclinical central lymph node metastasis in PTMC.

Keyword

Papillary thyroid microcarcinoma; tumor size; subclinical central lymph node metastasis

MeSH Terms

Follow-Up Studies
Humans
Lymph Node Excision
Lymph Nodes*
Male
Multivariate Analysis
Neoplasm Metastasis*
Risk Factors
Thyroid Gland*
Thyroidectomy
Thyroiditis, Autoimmune

Reference

1. Jung KW, Park S, Kong HJ, Won YJ, Lee JY, Park EC, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2008. Cancer Res Treat. 2011. 43:1–11.

2. Giordano D, Gradoni P, Oretti G, Molina E, Ferri T. Treatment and prognostic factors of papillary thyroid microcarcinoma. Clin Otolaryngol. 2010. 35:118–124.

3. 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.

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. 237:399–407.

5. Roh JL, Kim JM, Park CI. Lateral cervical lymph node metastases from papillary thyroid carcinoma: pattern of nodal metastases and optimal strategy for neck dissection. Ann Surg Oncol. 2008. 15:1177–1182.

6. Koh YW, Park JH, Kim JW, Lee SW, Choi EC. Endoscopic hemithyroidectomy with prophylactic ipsilateral central neck dissection via an unilateral axillo-breast approach without gas insufflation for unilateral micropapillary thyroid carcinoma: preliminary report. Surg Endosc. 2010. 24:188–197.

7. Chung YS, Choe JH, Kang KH, Kim SW, Chung KW, Park KS, et al. Endoscopic thyroidectomy for thyroid malignancies: comparison with conventional open thyroidectomy. World J Surg. 2007. 31:2302–2306.

8. Pelizzo MR, Boschin IM, Toniato A, Pagetta C, Piotto A, Bernante P, et al. Natural history, diagnosis, treatment and outcome of papillary thyroid microcarcinoma (PTMC): a mono-institutional 12-year experience. Nucl Med Commun. 2004. 25:547–552.

9. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994. 97:418–428.

10. Hay ID, Grant CS, Taylor WF, McConahey WM. Ipsilateral lobectomy versus bilateral lobar resection in papillary thyroid carcinoma: a retrospective analysis of surgical outcome using a novel prognostic scoring system. Surgery. 1987. 102:1088–1095.

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

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

13. 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.

14. 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. 144:980–987.

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

16. So YK, Son YI, Hong SD, Seo MY, Baek CH, Jeong HS, et al. Subclinical lymph node metastasis in papillary thyroid microcarcinoma: a study of 551 resections. Surgery. 2010. 148:526–531.

17. Pakdaman MN, Rochon L, Gologan O, Tamilia M, Garfield N, Hier MP, et al. Incidence and histopathological behavior of papillary microcarcinomas: study of 429 cases. Otolaryngol Head Neck Surg. 2008. 139:718–722.

18. Lee NS, Bae JS, Jeong SR, Jung CK, Lim DJ, Park WC, et al. Risk factors of lymph node metastasis in papillary thyroid microcarcinoma. J Korean Surg Soc. 2010. 78:82–86.

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

20. Roti E, Rossi R, Trasforini G, Bertelli F, Ambrosio MR, Busutti L, et al. Clinical and histological characteristics of papillary thyroid microcarcinoma: results of a retrospective study in 243 patients. J Clin Endocrinol Metab. 2006. 91:2171–2178.

21. Lee KJ, Cho YJ, Kim SJ, Lee SC, Kim JG, Ahn CJ, et al. Analysis of the clinicopathologic features of papillary thyroid microcarcinoma based on 7-mm tumor size. World J Surg. 2011. 35:318–323.

22. 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.

23. 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.

24. Lim YC, Choi EC, Yoon YH, Kim EH, Koo BS. Central lymph node metastases in unilateral papillary thyroid microcarcinoma. Br J Surg. 2009. 96:253–257.

25. Shaha AR, Shah JP, Loree TR. Risk group stratification and prognostic factors in papillary carcinoma of thyroid. Ann Surg Oncol. 1996. 3:534–538.

26. Besic N, Pilko G, Petric R, Hocevar M, Zgajnar J. Papillary thyroid microcarcinoma: prognostic factors and treatment. J Surg Oncol. 2008. 97:221–225.

27. Ito Y, Tomoda C, Uruno T, Takamura Y, Miya A, Kobayashi K, et al. Minimal extrathyroid extension does not affect the relapse-free survival of patients with papillary thyroid carcinoma measuring 4 cm or less over the age of 45 years. Surg Today. 2006. 36:12–18.

28. Moon HJ, Kim EK, Chung WY, Yoon JH, Kwak JY. Minimal extrathyroidal extension in patients with papillary thyroid microcarcinoma: is it a real prognostic factor? Ann Surg Oncol. 2011. 18:1916–1923.

29. Matsubayashi S, Kawai K, Matsumoto Y, Mukuta T, Morita T, Hirai K, et al. The correlation between papillary thyroid carcinoma and lymphocytic infiltration in the thyroid gland. J Clin Endocrinol Metab. 1995. 80:3421–3424.

30. Loh KC, Greenspan FS, Dong F, Miller TR, Yeo PP. Influence of lymphocytic thyroiditis on the prognostic outcome of patients with papillary thyroid carcinoma. J Clin Endocrinol Metab. 1999. 84:458–463.

31. Kim EY, Kim WG, Kim WB, Kim TY, Kim JM, Ryu JS, et al. Coexistence of chronic lymphocytic thyroiditis is associated with lower recurrence rates in patients with papillary thyroid carcinoma. Clin Endocrinol (Oxf). 2009. 71:581–586.

32. Kim HS, Choi YJ, Yun JS. Features of papillary thyroid microcarcinoma in the presence and absence of lymphocytic thyroiditis. Endocr Pathol. 2010. 21:149–153.

33. Kim JM, Kim TY, Kim WB, Gong G, Kim SC, Hong SJ, et al. Lymphovascular invasion is associated with lateral cervical lymph node metastasis in papillary thyroid carcinoma. Laryngoscope. 2006. 116:2081–2085.