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Fei Y, Wang B, Yao X, Wu J. Factors associated with occult lateral lymph node metastases in patients with clinically lymph node negative papillary thyroid carcinoma: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2024; 15:1353923. [PMID: 39493782 PMCID: PMC11527613 DOI: 10.3389/fendo.2024.1353923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 09/30/2024] [Indexed: 11/05/2024] Open
Abstract
Background It remains unclear which category of patients with clinically lymph node negative (cN0) papillary thyroid carcinoma (PTC) might have higher risk of occult lateral lymph node metastasis (OLLNM) due to the conflicting results in previous studies. This systematic review and meta-analysis aimed to investigate factors associated with OLLNM in patients with cN0 PTC. Methods PubMed, EMBASE, Cochrane Library and Web of Science were comprehensively searched by two independent investigators to 15 August 2022. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for the pooled analysis. This systematic review and meta-analysis was registered in PROSPERO (CRD42022353567). Results Fifteen eligible studies involving 8369 patients with cN0 PTC were included in this meta-analysis. We found 7 factors significantly associated with OLLNM, including male (OR, 1.47; 95% CI, 1.30 to 1.66; P < 0.001), age<45y (OR, 1.65; 95% CI, 1.31 to 2.06; P < 0.001), tumor size > 10mm (OR, 3.17; 95% CI, 2.04 to 4.93; P <0.001), tumor located in upper pole (OR, 1.81; 95% CI, 1.44 to 2.27; P <0.001), bilaterality (OR, 1.66; 95% CI, 1.37 to 2.02; P <0.001), extrathyroidal extension (ETE) (OR, 2.52; 95% CI, 1.72 to 3.68; P <0.001) and increased number of central lymph node metastasis (CLNM) (OR, 6.84; 95% CI, 5.66 to 8.27; P <0.001). The results of sensitivity analysis and subgroup analysis were similar to the pooled results. No significant publication bias was observed. Conclusions The systematic review and meta-analysis identified 7 factors associated with OLLNM in patients with cN0 PTC. Future studies are needed to validate our results. Systematic review registration https://www.crd.york.ac.uk/prospero, identifier CRD42022353567.
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Affiliation(s)
| | | | | | - Jian Wu
- Center of Breast and Thyroid Surgery, Department of General Surgery, The Third People’s Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
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Caliskan O, Unlu MT, Yanar C, Kostek M, Aygun N, Uludag M. Predictive Factors Affecting the Development of Lateral Lymph Node Metastasis in Papillary Thyroid Cancer. SISLI ETFAL HASTANESI TIP BULTENI 2023; 57:312-319. [PMID: 37900340 PMCID: PMC10600609 DOI: 10.14744/semb.2023.90235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 10/31/2023]
Abstract
Objectives Lateral lymph node metastasis (LLNM) in papillary thyroid cancer (PTC) determines the extent of surgery to be performed and the prognosis of the disease. In this study, we aimed to evaluate the clinicopathological risk factors affecting the development of LLNM. Methods We retrospectively evaluated the demographic and clinicopathological data of 346 cases with PTC who were operated in our clinic between May 2012 and September 2020. The patients were divided into 2 groups as patients with LLNM (Group 1) and without LLNM (Group 2). Results Thirty-six (10.4%) patients out of 346 patients with PTC had LLNM. A statistically significant difference was found between Group 1 and Group 2 regarding the male gender (M/F: 38.9% vs. 21.6%; p=0.020), tumor size (2.30±1.99 cm vs. 1.31±1.40 cm; p=0.000), lymphovascular invasion (69.4 vs. 20.6%; p=0.000), multicentricity (69.4% vs. 35.5%; p=0.000), multifocality (p=0.000), aggressive variant (22.2% vs. 9.4%; p=0.000), extrathyroidal extension (50% vs. 16.1% p=0.000), central lymph node metastasis (CLNM) rates (75% vs. 6.5%; p=0.000), and ≥3 cm lymph node metastasis (48.5% vs. 0%, p=0.000), distant metastasis (2.1% vs. 0%, p=0.000), respectively. Multivariance analysis determined the presence of CLNM as an independent risk factor for the development of LLNM. Conclusion The presence of CLNM in patients with PTC was determined as an independent risk factor for the development of LLNM. Although there has been increasing debate about prophylactic central neck dissection (pCND) in LLNM, pCND should still be considered in these patients as the rate of CLNM is high in patients with LLNM. CLNM might be a reference for surgeons to determine the extent of surgery. In addition, the presence of CLNM is important for close follow-up for the early detection of LLNM recurrence.
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Affiliation(s)
- Ozan Caliskan
- Division of Endocrine Surgery, Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Mehmet Taner Unlu
- Division of Endocrine Surgery, Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Ceylan Yanar
- Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Mehmet Kostek
- Division of Endocrine Surgery, Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Nurcihan Aygun
- Division of Endocrine Surgery, Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Mehmet Uludag
- Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
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Semerci O, Gucer H. The Significance of Unsampled Microscopic Thyroid Carcinomas in Multinodular Goiter. Endocr Pathol 2023; 34:119-128. [PMID: 36527546 DOI: 10.1007/s12022-022-09743-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
Thorough gross examination and appropriate sampling of the thyroidectomy specimens are fundamental to the diagnosis and clinical risk management of patients. This study aims to investigate the frequency and clinical significance of initially unsampled microscopic thyroid carcinomas in total thyroidectomy specimens with presumed benign multinodular thyroid disease. Seventy-two total thyroidectomy specimens belonging to multinodular goiter patients were randomly selected and included in this prospectively designed study. Inclusion criteria were set as no suspicion of malignancy before surgery as well as lack of intra-parenchymal primary thyroid carcinoma after histopathological evaluation of slides generated from initial sampling. Subsequently, the remaining thyroidectomy specimens were submitted for microscopic examination and sign-outs were finalized following the microscopic examination of the entire thyroid tissue. Microcarcinomas, with a maximum diameter of 3.5 mm, were detected in 29 cases (40.2%) after the whole gland sampling. Although most of these tumors were low-risk papillary microcarcinomas confined to the thyroid, one specimen also showed a medullary microcarcinoma measuring 1.5 mm. Three had micrometastatic nodal disease. There was no local recurrence or distant metastatic disease during the follow-up (mean 51.4 months). This study further supports microscopic carcinomas, including papillary microcarcinoma, and medullary microcarcinoma might stay hidden in thyroidectomy specimens. Increased glandular weight, male gender, and advanced age were significant risk factors in the detection of microcarcinomas in this series. While each multinodular thyroidectomy specimen is unique, we recommend dynamic extensive sampling (rather than bare-minimum approach) strategy based on careful gross and initial histologic examination findings as well as by taking into consideration risk factors.
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Affiliation(s)
- Orhan Semerci
- Department of Pathology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Hasan Gucer
- Department of Pathology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey.
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Feng H, Chen Z, An M, Chen Y, Chen B. Nomogram for preoperative prediction of high-volume lymph node metastasis in the classical variant of papillary thyroid carcinoma. Front Surg 2023; 10:1106137. [PMID: 36843997 PMCID: PMC9945534 DOI: 10.3389/fsurg.2023.1106137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/10/2023] [Indexed: 02/11/2023] Open
Abstract
Introduction The objective of our study was to construct a preoperative prediction nomogram for the classical variant of papillary thyroid carcinoma (CVPTC) patients with a solitary lesion based on demographic and ultrasonographic parameters that can quantify the individual probability of high-volume (>5) lymph node metastasis (HVLNM). Materials and methods In this study, a total of 626 patients with CVPTC from December 2017 to November 2022 were reviewed. Their demographic and ultrasonographic features at baseline were collected and analyzed using univariate and multivariate analyses. Significant factors after the multivariate analysis were incorporated into a nomogram for predicting HVLNM. A validation set from the last 6 months of the study period was conducted to evaluate the model performance. Results Male sex, tumor size >10 mm, extrathyroidal extension (ETE), and capsular contact >50% were independent risk factors for HVLNM, whereas middle and old age were significant protective factors. The area under the curve (AUC) was 0.842 in the training and 0.875 in the validation set. Conclusions The preoperative nomogram can help tailor the management strategy to the individual patient. Additionally, more vigilant and aggressive measures may benefit patients at risk of HVLNM.
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Affiliation(s)
- Huahui Feng
- Department of Medical Ultrasound, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Zheming Chen
- Department of Medical Ultrasound, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Maohui An
- Department of Medical Ultrasound, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Yanwei Chen
- Department of Medical Ultrasound, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
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Correlation Analysis of Nodular Sonographic Parameters with Cervical Lymph Node Metastases in Papillary Thyroid Carcinoma. BIOMED RESEARCH INTERNATIONAL 2022; 2022:4680064. [PMID: 35607302 PMCID: PMC9124110 DOI: 10.1155/2022/4680064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
Background Papillary thyroid carcinoma (PTC) is the most common thyroid carcinoma and is prone to cervical lymph node metastases (CLNM). We aim to analyze the correlation between clinical information, ultrasonic parameters of PTC, and CLNM. Methods 1335 patients who had pathologically confirmed unifocal PTC were enrolled in this retrospective cohort study. Univariate and multivariate logistic analyses were performed to predict CLNM in PTC patients. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance. Results Univariate analysis showed that gender, age, maximum tumor diameter and volume, and cross-sectional and longitudinal aspect ratio were related to CLNM (P < 0.05). Multivariate logistic analysis showed that gender, age, maximum tumor diameter, and volume were independent correlative factors, and the cross-sectional aspect ratio had significant difference for PTC2 to predict CLNM. The area under the curve (AUC) of the maximum tumor diameter and volume was 0.738 and 0.733, respectively. Maximum tumor diameter and volume and the cross-sectional and longitudinal aspect ratio were statistically significant following analysis of variance (P < 0.05). Conclusions Younger age, male, and larger tumor were high risk factors for CLNM in patients with unifocal PTC. The cross-sectional aspect ratio had a more effective predictive value for CLNM in patients with larger thyroid tumors.
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Kim MJ, Kim HJ, Park CS, Kim BW. Frozen section analysis of central lymph nodes in papillary thyroid cancer: the significance in determining the extent of surgery. Gland Surg 2022; 11:640-650. [PMID: 35531106 PMCID: PMC9068541 DOI: 10.21037/gs-22-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/04/2022] [Indexed: 12/23/2023]
Abstract
BACKGROUND The indolent feature of papillary thyroid cancer (PTC) has recently led to an increase in less aggressive treatment options instead of total thyroidectomy (TT). We aimed to investigate the clinical significance of elective central compartment neck dissection (CCND) with intraoperative frozen analyses of the central lymph nodes (LNs) to determine the surgical extent of unilateral clinically node-negative PTC. METHODS We retrospectively reviewed the medical records of 290 patients with unilateral clinically node-negative PTC who underwent surgery and performed frozen analyses of the central LNs from 2020 to 2021 using our own nodal criteria with cut-off size 5 mm. The patients were divided and investigated according to the surgical extent and the National Comprehensive Cancer Network (NCCN) guidelines; diagnostic accuracy of the frozen analyses was estimated. RESULTS TT was performed in 16.2% of patients. The TT group had more metastatic nodes with a larger size, higher LN ratio (LNR), and more extranodal extension. The analyses based on the NCCN guidelines showed similar findings, but more completion TT was required compared with our criteria. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the frozen analyses were 94.6%, 100%, 100%, and 96.1%, respectively. CONCLUSIONS Elective CCND with intraoperative frozen analyses is a highly reliable procedure that detects occult nodal metastasis in unilateral node-negative PTC patients. Our nodal criteria yielded significant aggressive nodal characteristics in the TT group while yielding less TTs compared with the NCCN guidelines. The concept and clinical significance of small-volume nodal metastasis in PTC should be further investigated.
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Affiliation(s)
- Min Jhi Kim
- Department of Surgery, CHA Ilsan Medical Center, Cha University School of Medicine, Goyang-si, South Korea
| | - Hee Jun Kim
- Department of Surgery, CHA Ilsan Medical Center, Cha University School of Medicine, Goyang-si, South Korea
| | - Cheong Soo Park
- Department of Surgery, CHA Ilsan Medical Center, Cha University School of Medicine, Goyang-si, South Korea
| | - Bup-Woo Kim
- Department of Surgery, CHA Ilsan Medical Center, Cha University School of Medicine, Goyang-si, South Korea
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Chen Y, Chen S, Lin X, Huang X, Yu X, Chen J. Clinical Analysis of Cervical Lymph Node Metastasis Risk Factors and the Feasibility of Prophylactic Central Lymph Node Dissection in Papillary Thyroid Carcinoma. Int J Endocrinol 2021; 2021:6635686. [PMID: 33603782 PMCID: PMC7868159 DOI: 10.1155/2021/6635686] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/04/2021] [Accepted: 01/17/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To identify the risk factors for cervical lymph node metastasis (CLNM) and the feasibility of prophylactic central lymph node dissection. METHODS The characteristics of 1107 patients were extracted and analyzed. Univariate and multivariate analyses were used to identify risk factors associated with lymph node metastasis. The relationship between the central lymph node dissection (CLND) and lateral lymph node metastasis (LLNM) was analyzed using the correlation analysis. RESULTS The probability of CLNM was closely related to the male gender, age <55, and the increase of tumor size. Those patients with an increase in tumor size and CLNM were extremely prone to LLNM. Also, LLNM was more likely to happen in those with the more positive central lymph nodes. Routine prophylactic central lymph node dissection (P-CLND) did not increase the risk of complications. CONCLUSION P-CLND should be considered as a reasonable surgical treatment for PTC.
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Affiliation(s)
- Yifan Chen
- Department of General Surgery, South Branch of Fujian Provincial Hospital, Fuzhou 350000, Fujian, China
- Provincial Clinical Medical College of Fujian Medical University, Fuzhou 350000, Fujian, China
| | - Shuo Chen
- Provincial Clinical Medical College of Fujian Medical University, Fuzhou 350000, Fujian, China
- Department of Gynaecology and Obstetrics, South Branch of Fujian Provincial Hospital, Fuzhou 350000, Fujian, China
| | - Xiaoying Lin
- Department of General Surgery, South Branch of Fujian Provincial Hospital, Fuzhou 350000, Fujian, China
- Provincial Clinical Medical College of Fujian Medical University, Fuzhou 350000, Fujian, China
| | - Xiangqing Huang
- Department of General Surgery, South Branch of Fujian Provincial Hospital, Fuzhou 350000, Fujian, China
- Provincial Clinical Medical College of Fujian Medical University, Fuzhou 350000, Fujian, China
| | - Xiaofang Yu
- Department of General Surgery, South Branch of Fujian Provincial Hospital, Fuzhou 350000, Fujian, China
- Department of Anesthesiology, South Branch of Fujian Provincial Hospital, Fuzhou 350000, Fujian, China
| | - Juying Chen
- Department of General Surgery, South Branch of Fujian Provincial Hospital, Fuzhou 350000, Fujian, China
- Provincial Clinical Medical College of Fujian Medical University, Fuzhou 350000, Fujian, China
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Rui ZY, Liu Y, Zheng W, Wang X, Meng ZW, Tan J, Li N, Jia Q. A retrospective study of the risk factors and the prognosis in patients with papillary thyroid carcinoma depending on the number of lymph node metastasis. Clin Exp Med 2021; 21:277-286. [PMID: 33386568 DOI: 10.1007/s10238-020-00675-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/20/2020] [Indexed: 02/07/2023]
Abstract
To retrospectively analyze the risk factors and the prognosis according to the number of lymph node metastases (LNMs) in different neck compartments in papillary thyroid carcinoma (PTC) patients. In total, 962 patients with PTC were enrolled in this study. According to the methods of the 2015 American Thyroid Association, the treatment response of the patients was divided into a good prognosis and a poor prognosis. First, their clinical characteristics were summarized. Then, according to whether they had LNMs and the number of LNMs in different neck compartments, their risk factors and their prognosis were analyzed. Male sex, younger (< 45 years), extrathyroid extension (ETE), T1 staging and higher stimulated thyroglobulin (sTg) levels were the risk factors for LNM. The cutoff for a poor prognosis of the number of LNMs was > 4. Male sex, younger age, higher sTg levels and ETE were correlated with LNM > 4. Furthermore, the cutoffs for a poor prognosis of central lymph node metastasis (CLNM), lateral lymph node metastasis (LLNM) and CLNM + LLNM were > 6, > 1 and > 5, respectively. Younger age and ETE were strongly correlated with CLNM > 6. Male sex, younger age, higher sTg levels and ETE were correlated with LLNM > 1. Younger age, ETE and higher sTg levels were correlated with CLNM + LLNM > 5. Further analysis revealed a positive correlation between CLNM and LLNM. We should pay more attention to LNMs in PTC patients who are male, are of a younger age, have ETE, T1 staging and have higher sTg levels. The neck regional LNMs should be correctly evaluated to guide the surgical options for the neck LNMs in PTC. When the number of LNMs in different neck compartments has exceeded the cutoff value, they can be considered as predictors of the outcome of 131I treatment.
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Affiliation(s)
- Zhong Ying Rui
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China
| | - Yang Liu
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China
| | - Wei Zheng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China.
| | - Xuan Wang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China
| | - Zhao Wei Meng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China
| | - Jian Tan
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China
| | - Ning Li
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China
| | - Qiang Jia
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China
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Huang Y, Yin Y, Zhou W. Risk Factors for Central and Lateral Lymph Node Metastases in Patients With Papillary Thyroid Micro-Carcinoma: Retrospective Analysis on 484 Cases. Front Endocrinol (Lausanne) 2021; 12:640565. [PMID: 33746905 PMCID: PMC7973362 DOI: 10.3389/fendo.2021.640565] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/01/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Papillary thyroid micro-carcinoma (PTMC) is defined as a tumor with a larger diameter ≤1 cm which has an indolent course and satisfying prognosis. However, the incidence of lymph node metastasis of PTMC cannot be ignored. The aim of this study was to assess the incidence of lymph node metastasis in PTMC patients, as well as to evaluate the risk factors for both central lymph node metastases (CLNM) and lateral lymph node metastases (LLNM). METHODS Patients who underwent thyroidectomy from January 2017 to October 2020, and pathologically diagnosed with PTMC were enrolled in our study and their medical records were collected and analyzed. RESULTS A total of 484 PTMC patients were included. The incidence of central and lateral lymph node metastasis was 49.6% and 9.1%, respectively. Multivariate analysis demonstrated as independent risk factors for CLNM male sex, age <40 years, largest tumor size ≥5 mm and bilaterality. Extrathyroidal extension, presence of CLNM, number of CLNM ≥5 were strong indicators for LLNM. CONCLUSION The incidence of lymph node metastases in PTMC is non-negligible. The identification of potential risk factors for CLNM and LLNM would help tailor individual surgical interventions for patients with PTMC.
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Li J, He G, Tong Y, Tao L, Xie L, Gao L, Zhang D. A NOVEL SCORING SYSTEM FOR THE RISK OF PAPILLARY THYROID CANCER METASTASES IN LYMPH NODES POSTERIOR TO THE RIGHT OF THE RECURRENT LARYNGEAL NERVE. Endocr Pract 2020; 27:15-20. [PMID: 33471728 DOI: 10.4158/ep-2020-0129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Some surgeons believe that dissection posterior to the right recurrent laryngeal nerve lymph node (PRRLN-LN) is unnecessary for the low metastasis rate and high complication risk. However, persistent metastatic lymph nodes may have a higher recurrence rate, surgical risk, and complications. Thus, it is important to distinguish patients who require PRRLN-LN dissection. To identify the risk factors for lymph nodes posterior to the right recurrent laryngeal nerve metastasis (LN-prRLN) and establish a scoring system to help determine whether PRRLN-LN dissection is required in patients with papillary thyroid carcinoma. METHODS 821 participants were randomly allocated to the development and validation cohorts in a 2:1 ratio. A nomogram-based predictive model for LN-prRLN was established based on the risk factors identified in the development cohort. RESULTS LN-prRLN was diagnosed pathologically in 124 of 821 patients (15.1%) from the entire cohort. Multivariate analysis identified age (odds ratio [OR], 0.964; 95% CI, 0.945-0.983; P < .001), tumor size (OR, 1.536; 95% CI, 1.135-2.079; P = .005), extrathyroidal extension (OR 2.271, 95% CI, 1.368-3.770; P = .002), clinically involved right central compartment lymph node metastasis (OR 1.643, 95% CI, 1.055-2.559; P = .028), and right lateral lymph node metastasis (OR 4.271, 95% CI, 2.325-7.844; P < .001) as the predictors of LN-prRLN. A risk model was established and well validated. Calibration curves to evaluate the nomogram in both the development and validation cohorts revealed a concordance index of 0.756 ± 0.058 and 0.745 ± 0.042, respectively. CONCLUSION Our scoring system may be useful for helping the surgeons decide which patients should undergo the dissection of PRRLN-LN.
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Affiliation(s)
- Jianbo Li
- Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Gaofei He
- Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yifan Tong
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Li Tao
- Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lei Xie
- Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Li Gao
- Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Deguang Zhang
- Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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武 元, 王 军, 刘 勤. [Predictors for central lymph node metastases in papillary thyroid microcarcinoma]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2020; 34:955-957. [PMID: 33254308 PMCID: PMC10128513 DOI: 10.13201/j.issn.2096-7993.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Indexed: 11/12/2022]
Abstract
In recent years, with the wide application of ultrasound in health examination, the incidence of papillary thyroid microcarcinoma（PTMC） is increasing rapidly. There is more controversy about whether prophylactic central lymph node dissection（PCND） should be performed in PTMC patients with clinical lymph node negative（cN0）. Some clinical and pathological factors were associated with central lymph node metastasis in patients with PTMC. This paper review the risk factors for predicting central lymph node metastasis so as to screen high-risk PTMC patients who need to receive PCND, and guide clinicians to choose reasonable individualized surgery.
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Affiliation(s)
- 元元 武
- 甘肃省肿瘤医院头颈外科 甘肃省头颈肿瘤外科临床医学中心(兰州，730050)
| | - 军 王
- 甘肃省肿瘤医院头颈外科 甘肃省头颈肿瘤外科临床医学中心(兰州，730050)
| | - 勤江 刘
- 甘肃省肿瘤医院头颈外科 甘肃省头颈肿瘤外科临床医学中心(兰州，730050)
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12
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Ieni A, Vita R, Cardia R, Giuffré G, Benvenga S, Tuccari G. BRAF Status in Papillary Microcarcinomas of the Thyroid Gland: a Brief Review. Curr Mol Med 2020; 19:665-672. [PMID: 31625469 DOI: 10.2174/1566524019666190717161359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 07/04/2019] [Accepted: 07/06/2019] [Indexed: 12/23/2022]
Abstract
Papillary thyroid microcarcinoma (PTMC) is defined by the World Health Organization as papillary cancer measuring 10 mm or less in diameter. Generally, PTMC shows an indolent clinical behavior with a good prognosis, although a minority of PTMC is characterized by an aggressive course. However, efforts to identify this aggressive subset of PTMC after surgery remain inconclusive. Several oncogenic pathways have been identified in thyroid cancer and have been applied translationally to improve prognosis and clinical management. In particular, the BRAFV600E mutation was found more frequently in large, aggressive, recurrent and advanced tumors. We aimed at reviewing studies on BRAFV600E mutation as a prognostic factor in PTMC.
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Affiliation(s)
- Antonio Ieni
- Department of Human Pathology "Gaetano Barresi" - Section of Pathological Anatomy, A.O.U. Polyclinic G.Martino, 98125 Messina, Italy
| | - Roberto Vita
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Roberta Cardia
- Department of Human Pathology "Gaetano Barresi" - Section of Pathological Anatomy, A.O.U. Polyclinic G.Martino, 98125 Messina, Italy
| | - Giuseppe Giuffré
- Department of Human Pathology "Gaetano Barresi" - Section of Pathological Anatomy, A.O.U. Polyclinic G.Martino, 98125 Messina, Italy
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,Master Program on Childhood, Adolescent and Women's Endocrine Health, University of Messina, Messina, Italy.,Interdepartmental Program of Molecular & Clinical Endocrinology, and Women's Endocrine Health, University of Messina, Messina, Italy
| | - Giovanni Tuccari
- Department of Human Pathology "Gaetano Barresi" - Section of Pathological Anatomy, A.O.U. Polyclinic G.Martino, 98125 Messina, Italy
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Mao J, Zhang Q, Zhang H, Zheng K, Wang R, Wang G. Risk Factors for Lymph Node Metastasis in Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2020; 11:265. [PMID: 32477264 PMCID: PMC7242632 DOI: 10.3389/fendo.2020.00265] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/09/2020] [Indexed: 12/31/2022] Open
Abstract
Purpose: To explore the risk factors that may predict the lymph node metastasis potential of these lesions and new prevention strategies in papillary thyroid carcinoma patients. Materials and Methods: In total, 9,369 papillary thyroid carcinoma patients with 37.17% lymph node metastasis were analyzed (Revman 5.3 software) in this study. The PubMed and Embase databases were used for searching works systematically that were published through to January 22, 2020. Results: Several factors were related to the increased risk of lymph node metastasis in patients with papillary thyroid carcinoma: age <45 years (pooled OR = 1.52, 95% CI = 1.14-2.01, p <0.00001); gender = male (pooled OR = 1.68, 95% CI = 1.51-1.87, p <0.00001); multifocality (pooled OR = 2.05, 95% CI = 1.45-2.89, p <0.0001); tumor size ≥1.0 cm (pooled OR = 3.53, 95% CI = 2.62-4.76, p <0.00001); tumor location at the upper pole 1/3 (pooled OR =1.46, 95% CI = 1.04-2.04, p = 0.03); capsular invasion + (pooled OR = 3.48, 95% CI = 1.69-7.54, p = 0.002); and extrathyroidal extension + (pooled OR = 2.03, 95% CI= 1.78-2.31, p <0.00001). However, tumor bilaterality (pooled OR = 0.85, 95% CI = 0.54-1.34, p = 0.49) and Hashimoto's thyroditis (pooled OR = 1.08, 95% CI = 0.79-1.49, p = 0.62) showed no correlation with lymph node metastasis in papillary thyroid carcinoma patients. Conclusion: The systematic review and meta-analysis defined several significant risk factors of lymph node metastasis in papillary thyroid cancer patients: age (<45 years), gender (male), multifocality, tumor size (>1 cm), tumor location (1/3 upper), capsular invasion, and extra thyroidal extension. Bilateral tumors and Hashimoto's thyroiditis were unrelated to lymph node metastasis in patients with papillary thyroid cancer.
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Affiliation(s)
- Jingxin Mao
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
- College of Pharmaceutical Sciences, Southwest University, Chongqing, China
| | - Qinghai Zhang
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
- College of Food Science, Guizhou Medical University, Guiyang, China
| | - Haiyan Zhang
- Institute of Deep-Sea Science and Engineering, Chinese Academy of Science, Sanya, China
| | - Ke Zheng
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Wang
- Department of Pharmacology, College of Pharmacy, Guilin Medical University, Guilin, China
| | - Guoze Wang
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
- College of Food Science, Guizhou Medical University, Guiyang, China
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Heng Y, Yang Z, Zhou L, Lin J, Cai W, Tao L. Risk stratification for lateral involvement in papillary thyroid carcinoma patients with central lymph node metastasis. Endocrine 2020; 68:320-328. [PMID: 31983029 DOI: 10.1007/s12020-020-02194-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 01/05/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To effectively predict lateral neck lymph nodes (LLN) metastasis in papillary thyroid carcinoma (PTC) patients with central lymph nodes (CLN) invasion, and devise targeted treatment strategies. METHODS Four hundred and thirty-four PTC patients with CLN metastasis from two medical centers were retrospectively analyzed. A new statistical model was established for predicting LLN involvement in these patients to guide lymph nodes management strategies. RESULTS Patients with more than five positive CLN metastasis appeared to have extremely high risk (83.0%) of LLN involvement. For patients with five or less positive CLN invasion, multivariate logistic analyses were applied. Independent risk factors for LLN involvement were determined to be: age over 40, maximum tumor diameter of no less than 1.0 cm, existence of thyroid capsular invasion, and tumor with ipsilateral nodular goiter (iNG). These factors were used to construct a predictive nomogram. The accuracy and validity of our newly built model were verified by C-index 0.761 (95% CI, 0.707-0.815) in development cohort and 0.759 (95% CI, 0.745-0.773) in validation cohort and calibration curve. The patients were stratified into three groups based on their nomogram risk scores. Possible LLN involvement rates for low-risk, moderate-risk, and relatively high-risk subgroups were 8.9%, 22.8%, and 48.2%, respectively. CONCLUSIONS Our newly established model can effectively predict possible LLN metastasis in PTC patients, and a new strategy selection flow chart was created for patients with positive CLN invasion. For patients in high-risk group, prophylactic LLN dissection is recommended, if not, adjuvant radioactive iodine or a closer follow-up scheme should at least be conducted. For those in low-risk group, surgical intervention is unnecessary and regular follow-up is recommended.
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Affiliation(s)
- Yu Heng
- Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Zheyu Yang
- Department of General Surgery, School of medicine affiliated Ruijin Hospital, Shanghai Jiaotong University, 197 Ruijin 2nd Road, Shanghai, 200031, China
| | - Liang Zhou
- Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Jianwei Lin
- Department of General Surgery, School of medicine affiliated Ruijin Hospital, Shanghai Jiaotong University, 197 Ruijin 2nd Road, Shanghai, 200031, China
| | - Wei Cai
- Department of General Surgery, School of medicine affiliated Ruijin Hospital, Shanghai Jiaotong University, 197 Ruijin 2nd Road, Shanghai, 200031, China.
| | - Lei Tao
- Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
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15
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Wu X, Li BL, Zheng CJ, He XD. Predictive factors for central lymph node metastases in papillary thyroid microcarcinoma. World J Clin Cases 2020; 8:1350-1360. [PMID: 32368529 PMCID: PMC7190943 DOI: 10.12998/wjcc.v8.i8.1350] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 03/04/2020] [Accepted: 04/04/2020] [Indexed: 02/05/2023] Open
Abstract
Papillary thyroid microcarcinoma (PTMC) measures 1 cm or less in its longest dimension. The incidence of PTMC is increasing worldwide. Surgery is the primary treatment; however, prophylactic central lymph node dissection is controversial, and discrepancies between different guidelines have been noted. Routine prophylactic central lymph node dissection may result in hypoparathyroidism and recurrent laryngeal nerve injury in some patients without lymph node metastasis, while simple thyroidectomy may leave metastatic lymph nodes in high-risk patients. To selectively perform prophylactic lymph node dissections in high-risk patients, it is important to identify predictive factors for lymph node metastases in patients with PTMC. Several studies have reported on this, but their conclusions are not entirely consistent. Several clinicopathologic characteristics have been identified as risk factors for central lymph node metastases, and the most commonly reported factors include age, gender, tumor size and location, multifocality, bilaterality, extrathyroidal extension, and abnormal lymph node found using ultrasound. Here, we provide an overview of previous studies along with a favorable opinion on or against these factors, with the aim of increasing the understanding of this topic among the medical community. In addition, current opinions about prophylactic central lymph node dissection are reviewed and discussed.
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Affiliation(s)
- Xin Wu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Bing-Lu Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Chao-Ji Zheng
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiao-Dong He
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Xue S, Han Z, Lu Q, Wang P, Chen G. Clinical and Ultrasonic Risk Factors for Lateral Lymph Node Metastasis in Papillary Thyroid Microcarcinoma: A Systematic Review and Meta-Analysis. Front Oncol 2020; 10:436. [PMID: 32309215 PMCID: PMC7145902 DOI: 10.3389/fonc.2020.00436] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 03/11/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Clinical and ultrasonic risk factors for lateral lymph node metastasis (LLNM) in papillary thyroid microcarcinoma (PTMC) are not well-defined. Herein, a systematic review and meta-analysis was conducted to investigate clinicopathologic and ultrasonic risk features for LLNM in PTMC. Methods: A systematic search of electronic databases (PubMed, Embase, Cochrane Library, and Web of Science) for studies published until April 2019 was performed. Case–control studies and randomized controlled trials that studied clinical and ultrasonic risk factors of LLNM in PTMC were included. Results: Fourteen studies (all retrospective studies) involving 43,750 patients met final inclusion criteria. From the pooled analyses, younger age<45 (OR, 1.55; 95% CI, 1.16–2.07; P = 0.003), male patients (OR, 1.94; 95% CI, 1.55–2.42; P < 0.00), extrathyroidal extension (OR, 3.63; 95% CI, 2.28–5.77; P <0.00), tumor multifocality (OR, 2.24; 95% CI, 1.53–3.28; P <0.00), tumor > 0.5 cm (OR, 2.24; 95% CI, 1.53–3.28; P < 0.00), central lymph node metastasis (OR, 5.61; 95% CI, 4.64–6.79; P < 0.00), >25% tumor contact with thyroid capsule (OR, 6.66; 95% CI, 1.96–22.65; P = 0.002), tumor calcification (OR, 2.90; 95% CI, 1.71–4.93; P < 0.00), upper tumor (OR, 3.18; 95% CI, 2.23–4.55; P < 0.00) were significantly associated with increased risk of LLNM in PTMC, while Hashimoto's thyroiditis and other ultrasonic features (solid tumor, hypoechoic tumor, smooth margin, and taller than wide tumor) were not significantly associated with LLNM in PTMC. Conclusions: Our analysis identified several clinicopathologic and ultrasonic factors associated with LLNM in PTMC. This finding highlights the need for a cautious and frequent postoperative surveillance of the lateral neck in high-risk PTMC patients. Moreover, high-risk ultrasonic features also need to be considered during selection of PTMC for active surveillance.
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Affiliation(s)
- Shuai Xue
- Department of Thyroid Surgery, The 1st Hospital of Jilin University, Changchun, China
| | - Zhe Han
- Department of Thyroid Surgery, The 1st Hospital of Jilin University, Changchun, China
| | - Qiyu Lu
- Department of Thyroid Surgery, The 1st Hospital of Jilin University, Changchun, China
| | - Peisong Wang
- Department of Thyroid Surgery, The 1st Hospital of Jilin University, Changchun, China
| | - Guang Chen
- Department of Thyroid Surgery, The 1st Hospital of Jilin University, Changchun, China
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Ruiz Pardo J, Ríos A, Rodríguez JM, Paredes M, Soriano V, Oviedo MI, Hernández AM, Parrilla P. Risk Factors of Metastatic Lymph Nodes in Papillary Thyroid Microcarcinoma. Cir Esp 2020; 98:219-225. [PMID: 31980154 DOI: 10.1016/j.ciresp.2019.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/26/2019] [Accepted: 10/20/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Papillary thyroid microcarcinoma (PTMC) usually has an indolent course, but some have worse prognostic factors, such as the presence of central (6.9%-51.5%) and lateral (3%-49.6%) lymph node metastases. The aim of this study is to analyze the factors associated with PTMC with metastatic lymph nodes and its long-term prognosis. METHODS Retrospective study whose study population consists of patients with PTMC (size ≤1cm). Patients with previous thyroid surgery, other synchronous malignancies and ectopic location of the PTMC were excluded. Two groups were compared: PTMC without metastatic lymph nodes (group 1) and PTMC with metastatic lymph nodes (group 2). A multivariate analysis using a logistic regression model and a Kaplan-Meier survival analysis with log-rank test were performed. RESULTS Out of the 161 selected patients, 9.3% (n=15) had metastatic lymph nodes. Multifocality (OR 5.284, 95%CI 1.056-26.443; P=.043) and extrathyroidal extension (OR 7.687, 95%CI 1.405-42.050; P=.019) were associated with the presence of metastatic lymph nodes. In PTMC with metastatic lymph nodes, more aggressive treatments were performed: lymphadenectomy (4.8% vs. 100%; P<.001) and radioactive iodine (24.7% vs. 100%; P<.001). During a mean follow-up of 119.8±65 months, one recurrence was detected in group 2 (0% vs. 6.7%; P=.093). No patients died due to the disease. CONCLUSIONS Multifocality and extrathyroidal extension of PTMC were associated with the presence of metastatic lymph nodes. Metastatic PTMC, with more aggressive treatments, presents an excellent long-term prognosis.
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Affiliation(s)
- José Ruiz Pardo
- Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
| | - Antonio Ríos
- Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Instituto Murciano de Investigación Bio-Sanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, España; Departamento de Cirugía, Pediatría y Obstetricia, y Ginecología, Universidad de Murcia, Murcia, España
| | - José M Rodríguez
- Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Instituto Murciano de Investigación Bio-Sanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, España; Departamento de Cirugía, Pediatría y Obstetricia, y Ginecología, Universidad de Murcia, Murcia, España
| | - Miriam Paredes
- Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Víctor Soriano
- Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - María I Oviedo
- Servicio de Anatomía Patológica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Antonio M Hernández
- Servicio de Endocrinología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Pascual Parrilla
- Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Instituto Murciano de Investigación Bio-Sanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, España; Departamento de Cirugía, Pediatría y Obstetricia, y Ginecología, Universidad de Murcia, Murcia, España
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Hammad MO, Elabbasy LM, Abd Elghaffar MA, Zaki MMA, Bazeed FB, Zahran MA. Significance of CEP78 and WDR62 gene expressions in differentiated thyroid carcinoma: Possible predictors of lateral lymph node metastasis. Asia Pac J Clin Oncol 2019; 15:e154-e161. [PMID: 30884127 DOI: 10.1111/ajco.13143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/17/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study aimed at investigating the clinical significance of CEP78 and WDR62 in differentiated thyroid carcinoma (DTC). This study also aimed at finding predictors that help in detecting patients with DTC who have high risk for lateral lymph node metastasis (LNM). METHODS Quantitative real-time polymerase chain reaction (RT-qPCR) was performed to examine CEP78, and WDR62 mRNA expressions in 40 tissue specimens of DTC, and 40 goiter tissue specimens. Additionally, we reviewed clinical, ultrasound, laboratory, pathological data of patients to analyze the associations between these characteristics and lateral LNM. RESULTS Our results demonstrated that relative CEP78 mRNA levels were significantly decreased in thyroid cancer tissues than goiter tissues (P = 0.002). ROC curve analysis confirmed the diagnostic value of CEP78 mRNA expression, providing an AUC equals to 0.698 (95% confidence intervals (CI), 0.583-0.813; P = 0.002). The relative WDR62 mRNA expression was not statistically different in DTC tissues and goiter tissues (P = 0.686). Furthermore, the DTC patients had been included to examine risk factors for lateral LNM. In multivariate analysis, the significant factors for predicting lateral LNM were low CEP78 mRNA expression (cut off value ≤0.54; P = 0.03; OR = 19.62; 95% CI, 1.3-296.23), central LNM (P = 0.011; OR = 33.6; 95% CI, 2.24-503.6) and calcifications (P = 0.023; OR = 27.187; 95% CI, 1.57-469.5). CONCLUSIONS CEP78 can be used as a promising molecular biomarker for differentiation between DTC and goiter tissues, in addition it might serve as a predictor of lateral LNM in DTC along with central LNM and calcifications. Unlike CEP78, WDR62 mRNA expression was not statistically different in DTC and goiter.
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Affiliation(s)
- Maha O Hammad
- Medical Biochemistry Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Lamiaa M Elabbasy
- Medical Biochemistry Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Marwa M A Zaki
- Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Fagr B Bazeed
- Medical Biochemistry Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohammed A Zahran
- Medical Biochemistry Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Luo Y, Zhao Y, Chen K, Shen J, Shi J, Lu S, Lei J, Li Z, Luo D. Clinical analysis of cervical lymph node metastasis risk factors in patients with papillary thyroid microcarcinoma. J Endocrinol Invest 2019; 42:227-236. [PMID: 29876836 PMCID: PMC6394766 DOI: 10.1007/s40618-018-0908-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 05/26/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE Lymph node metastasis (LNM) is a vital prognosis factor in patients with papillary thyroid microcarcinoma (PTMC). The study tried to identify clinicopathological factors for LNM of PTMC. METHODS The clinicopathological data of 1031 patients with PTMC were extracted and analyzed. Univariate and multivariate analyses were used to identify risk factors associated with cervical lymph node metastasis. ROC analysis was used to determine the ideal critical points of the sum of the maximum diameter of multifocal in a unilateral lobe. RESULTS The probability of LNM, central lymph node metastasis (CLNM) and lateral lymph node metastasis(LLNM)of PTMC patients were 35.6, 33.7 and 5.6%, respectively. In addition, 1.9% PTMC had LLNM only. Male, age ≤ 40 years, tumor largest diameter ≥ 5 mm, multifocal, non-uniform echoic distribution, the sum of the maximum diameter of multifocal in a unilateral lobe ≥ 8.5 mm, tumors in the lower pole location were prone to CLNM. Ultrasound mix-echo, the sum of the maximum diameter of the multifocal ≥ 10.75 mm, tumors in the upper pole location were extremely prone to LLNM. T3 were prone to LLNM or skip LLNM. CONCLUSIONS According to the clinicopathological characteristics of PTMC, the cervical lymph nodes should be correctly evaluated to guide the surgical treatment.
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Affiliation(s)
- Y. Luo
- West China School of Medicine, Sichuan University, Sichuan, China
| | - Y. Zhao
- Department of General Surgery, Zhang jia-gang First People’s Hospital, Jiangsu, China
| | - K. Chen
- Department of General Surgery, Zhang jia-gang First People’s Hospital, Jiangsu, China
| | - J. Shen
- Nanjing Medical University, Jiangsu, China
| | - J. Shi
- Department of Surgical Oncology, Hangzhou First People’s Hospital, Nanjing Medical University, No. 261, Huansha Road, Shangcheng district, Hangzhou, 310006 Zhejiang China
| | - S. Lu
- Zhejiang Chinese Medical University, Zhejiang, China
| | - J. Lei
- Thyroid Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Z. Li
- West China School of Medicine, Sichuan University, Sichuan, China
| | - D. Luo
- Department of Surgical Oncology, Hangzhou First People’s Hospital, Nanjing Medical University, No. 261, Huansha Road, Shangcheng district, Hangzhou, 310006 Zhejiang China
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20
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Xue S, Wang P, Zhang Q, Yin Y, Guo L, Wang M, Jin M, Chen G. Routine Lateral Level V Dissection May Not Be Necessary for Papillary Thyroid Microcarcinoma With Lateral Lymph Node Metastasis: A Retrospective Study of 252 Cases. Front Endocrinol (Lausanne) 2019; 10:558. [PMID: 31481929 PMCID: PMC6710992 DOI: 10.3389/fendo.2019.00558] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/29/2019] [Indexed: 12/27/2022] Open
Abstract
Background: Lateral lymph node metastasis (LLNM) is associated with distant metastasis, locoregional recurrence and cancer-specific mortality, although the prevalence of LLNM among patients with papillary thyroid microcarcinoma (PTMC) is relatively low. The potential benefits and risks of routine lateral level V dissection (LVD) for PTMC with LLNM have not been previously investigated. Methods: A total of 6,880 consecutive PTMC patients who underwent initial surgery at the First Hospital of Jilin University from January 2009 to July 2017 were retrospectively analyzed. A total of 252 N1b PTMC patients were enrolled in our study. Results: The overall and occult metastasis rates in level V lymph nodes were 21.4 and 6.4%, respectively. Patients with N1b PTMC who received LVD did not show a significantly lower disease-free survival (DFS) than that of patients who did not receive LVD [hazard ratio = 1.11 (CI 0.38-3.21); p = 0.85]. Meanwhile, LVD simultaneously increased the hospital stay and cost (p = 0.03; 0.02). Multivariate logistic regression analysis revealed that 3-level simultaneous metastasis in the lateral neck was an independent risk factor for level V metastasis [odds ratio = 8.6 (CI 1.42-51.72); p = 0.02]. Conclusions: Because of the low metastasis rate in level V lymph nodes, the lack of benefit for recurrence, the longer hospital stay and the higher cost associated with LVD, N1b PTMC patients without clinical level V metastasis may not need to undergo routine dissection. Prophylactic LVD may be recommended only for patients with N1b PTMC with 3-level simultaneous metastasis.
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Affiliation(s)
- Shuai Xue
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, China
| | - Peisong Wang
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, China
| | - Qiang Zhang
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, China
| | - Yue Yin
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, China
| | - Liang Guo
- Department of Pathology, The First Hospital of Jilin University, Changchun, China
| | - Ming Wang
- Department of Pathology, The First Hospital of Jilin University, Changchun, China
| | - Meishan Jin
- Department of Pathology, The First Hospital of Jilin University, Changchun, China
- *Correspondence: Meishan Jin
| | - Guang Chen
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, China
- Guang Chen
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Luo Y, Xu XC, Shen J, Shi JJ, Lu S, He W, Lei JY, Luo DC. Model of lymph node metastasis posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma. Cancer Manag Res 2018; 10:2449-2455. [PMID: 30122994 PMCID: PMC6084087 DOI: 10.2147/cmar.s167997] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Cervical lymph node metastasis (LNM) is a prognostic factor of papillary thyroid carcinoma (PTC). The way to deal with lymph node posterior to the right recurrent laryngeal nerve (LN-prRLN) is controversial. Nevertheless, if metastatic lymph nodes are not removed during the first operation, the subsequent salvage surgery of recurrent tumor in this area would entail high risk and complication. The purpose of this study was to develop a preoperative prediction model for LN-prRLN metastasis in PTC patients using clinicopathological characteristics. Patients and methods We performed a prospective study of 595 patients with PTC who underwent LN-prRLN dissection from March 2014 to June 2017. The clinicopathological data were randomly divided into derivation (n=476) and validation sets (n=119). A predictive model was initially established based upon the data of the derivation set via multivariate analyses, and the accuracy of the model was then examined with data of the validation set. The discriminative power of this model was assessed in both sets. Results Metastases of the LN-prRLN were identified in 102 (17.14%) of 595 patients. Age (odds ratio [OR] 0.971, 95% CI, 0.949–0.994, p=0.013), tumor size (OR 2.163, 95% CI, 1.431–3.270, p<0.001), capsular invasion (OR 1.934, 95% CI, 1.062–3.522, p=0.031), and right LNM (OR 3.786, 95% CI, 2.012–7.123, p<0.001) were significantly associated with LN-prRLN metastasis. The areas under the curves were 0.790 for the derivation set (sensitivity 71.95%, specificity 78.68%) and 0.878 for the validation set (sensitivity 85.00%, specificity 78.79%). Conclusion We developed and validated the first model to predict LN-prRLN metastases in patients with PTC based on clinicopathological parameters.
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Affiliation(s)
- Yi Luo
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Xiao-Cheng Xu
- Department of Surgery of Thyroid and Breast, Wujiang District of Suzhou First People's Hospital, Suzhou, China
| | - Jie Shen
- Clinical Medical College, Nanjing Medical University, Nanjing, China
| | - Jing-Jing Shi
- Department of Surgical Oncology, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, China,
| | - Si Lu
- Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wei He
- Department of Oncology, Taixing People's Hospital, Taixing, China
| | - Jian-Yong Lei
- Department of Thyroid Surgery, West China hospital of Sichuan University, Chengdu, China
| | - Ding-Cun Luo
- Department of Surgical Oncology, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, China,
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So YK, Kim MJ, Kim S, Son YI. Lateral lymph node metastasis in papillary thyroid carcinoma: A systematic review and meta-analysis for prevalence, risk factors, and location. Int J Surg 2018; 50:94-103. [PMID: 29329789 DOI: 10.1016/j.ijsu.2017.12.029] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/20/2017] [Accepted: 12/31/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Lymph node metastasis (LNM) is frequent in papillary thyroid carcinoma (PTC) and is associated with a poor prognosis. Unlike central LNM (CLNM), there are few studies focusing on LLNM. We aimed to investigate the prevalence and the risk factors for LLNM, with its most prevalent sites. METHODS We performed a comprehensive literature search using the PubMed and EMBASE databases for relevant studies published prior to November 2016 that examined the risk factors for LLNM. RESULTS Twenty-three studies, including 18,741 patients, were included. The prevalence of LLNM was 20.9% in all patients. CLNM (pooled OR = 7.84, 95% CI = 6.13-10.02, p < .0001), extrathyroidal extension (pooled OR = 3.22, 95% CI = 2.21-4.70, p < .0001), tumor multifocality (pooled OR = 2.19, 95% CI = 1.67-2.89, p < .0001), male sex (pooled OR = 1.72, 95% CI = 1.50-1.98, p < .0001), upper pole location (pooled OR = 2.96, 95% CI = 1.93-4.53, p < .0001), tumor size ≥1.0 cm (pooled OR = 2.49, 95% CI = 1.71-3.61, p < .0001), lymphovascular invasion (pooled OR = 3.96, 95% CI = 2.61-6.03, p < .0001) and tumor bilaterality (pooled OR = 1.31, 95% CI = 1.12-1.53, p = .0006) were significantly associated with LLNM. Most frequently affected areas were levels III and IV. CONCLUSIONS The prevalence of LLNM was high although the prognostic impact is unknown. The significant risk factors for LLNM were not much different from known risk factors for CLNM.
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Affiliation(s)
- Yoon Kyoung So
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Min-Ji Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Seonwoo Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Young-Ik Son
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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