Abstract
Background
Although lymph node (LN) metastasis (LNM) of papillary thyroid carcinoma (PTC) is common, routine prophylactic LN dissection (LND) is still controversial. The purpose of this study was to investigate risk factors for recurrence of PTC with clinically node-negative lateral neck to determine the utility of intraoperative LN biopsy.
Materials and methods
This study involved 185 patients with pathologically confirmed PTC and clinically node-negative lateral neck. All patients underwent thyroidectomy with or without ipsilateral or bilateral central LND after intraoperative central LN biopsy. Routine lateral neck LND was not performed. Clinicopathologic and intraoperative findings and post-treatment recurrences were recorded. Univariate and multivariate analyses with Cox-proportional hazards model were used to identify factors associated with recurrence.
Results
During a follow-up of 50–96 months, six (3.2 %) patients had recurrences in lateral cervical LNs at a median 28 months (range 7–57 months) after surgery. Overall, 2- and 5-year RFS rates were 98.4 and 96.7 %, respectively. Univariate analyses revealed that tumor size (P = 0.005), bilaterality (P = 0.033), T4 disease (P < 0.001), and intraoperative diagnosis of central LNM (P = 0.001) were significantly predictive of recurrence. Multivariate analyses showed that T4 disease (P = 0.049) and intraoperative diagnosis of central LNM (P = 0.027) were independently predictive of recurrence.
Conclusions
Prophylactic lateral neck LND is not advocated for PTC with clinically node-negative lateral neck. Intraoperative LN biopsy may help identify patients at risk for recurrence and those who would benefit from LND.
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References
Ezaki H, Ebihara S, Fujimoto Y et al (1992) Analysis of thyroid carcinoma based on material registered in Japan during 1977–1986 with special reference to predominance of papillary type. Cancer 70:808–814
Xing M, Alzahrani AS, Carson KA et al (2013) Association between BRAF V600E mutation and mortality in patients with papillary thyroid cancer. JAMA 309:1493–1501
Shaha AR, Shah JP, Loree TR (1996) Patterns of nodal and distant metastasis based on histologic varieties in differentiated carcinoma of the thyroid. Am J Surg 172:692–694
Wada N, Duh QY, Sugino K et al (2003) Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg 237:399–407
Sivanandan R, Soo KC (2001) Pattern of cervical lymph node metastases from papillary carcinoma of the thyroid. Br J Surg 88:1241–1244
Roh JL, Kim JM, Park CI (2008) Lateral cervical lymph node metastases from papillary thyroid carcinoma: pattern of nodal metastases and optimal strategy for neck dissection. Ann Surg Oncol 15:1177–1182
Lundgren CI, Hall P, Dickman PW et al (2006) Clinically significant prognostic factors for differentiated thyroid carcinoma: a population-based, nested case-control study. Cancer 106:524–531
Mazzaferri EL, Doherty GM, Steward DL (2009) The pros and cons of prophylactic central compartment lymph node dissection for papillary thyroid carcinoma. Thyroid 19:683–689
Pereira JA, Jimeno J, Miquel J et al (2005) Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma. Surgery 138:1095–1100
Mulla MG, Knoefel WT, Gilbert J et al (2012) Lateral cervical lymph node metastases in papillary thyroid cancer: a systematic review of imaging-guided and prophylactic removal of the lateral compartment. Clin Endocrinol (Oxf) 77:126–131
Cooper DS, Doherty GM, Haugen BR et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214
Stack BC Jr, Ferris RL, Goldenberg D et al (2012) American Thyroid Association (ATA) Consensus Review of the Anatomy, Terminology and Rationale for Lateral Neck Dissection in Differentiated Thyroid Cancers. Thyroid 22:501–508
Edge SB, Byrd DR, Compton CC, et al (eds) (2010) AJCC cancer staging manual. 7th ed. Springer, New York, p 87–96
Koo BS, Choi EC, Yoon YH et al (2009) Predictive factors for ipsilateral or contralateral central lymph node metastasis in unilateral papillary thyroid carcinoma. Ann Surg 249:840–844
Tisell LE, Nilsson B, Mölne J et al (1996) Improved survival of patients with papillary thyroid cancer after surgical microdissection. World J Surg 20:854–859. doi:10.1007/s002689900130
Dzodic R, Markovic I, Inic M et al (2006) Sentinel lymph node biopsy may be used to support the decision to perform modified radical neck dissection in differentiated thyroid carcinoma. World J Surg 30:841–846. doi:10.1007/s00268-005-0298-0
Ji YB, Lee KJ, Park YS et al (2012) Clinical efficacy of sentinel lymph node biopsy using methylene blue dye in clinically node-negative papillary thyroid carcinoma. Ann Surg Oncol 19:1868–1873
Ducoudray R, Trésallet C, Godiris-Petit G et al (2013) Prophylactic lymph node dissection in papillary thyroid carcinoma: is there a place for lateral neck dissection? World J Surg 37:1584–1591. doi:10.1007/s00268-013-2020-y
Lim YS, Lee JC, Lee YS et al (2011) Lateral cervical lymph node metastases from papillary thyroid carcinoma: predictive factors of nodal metastasis. Surgery 150:116–121
Ito Y, Higashiyama T, Takamura Y et al (2007) Risk factors for recurrence to the lymph node in papillary thyroid carcinoma patients without preoperatively detectable lateral node metastasis: validity of prophylactic modified radical neck dissection. World J Surg 31:2085–2091. doi:10.1007/s00268-007-9224-y
Hay ID, Bergstralh EJ, Goellner JR et al (1993) Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery 114:1050–1057
Laverick S, Lowe D, Brown JS et al (2004) The impact of neck dissection on health-related quality of life. Arch Otolaryngol Head Neck Surg 130:149–154
Terrell JE, Welsh DE, Bradford CR et al (2000) Pain, quality of life and spinal accessory nerve status after neck dissection. Laryngoscope 110:620–626
Acknowledgments
This study was supported by Grants (No. 2014-0306) from the Asan Institute for Life Science (J.-L. Roh).
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Lee, C.W., Gong, G. & Roh, JL. Intraoperative Diagnosis of Central Compartment Lymph Node Metastasis Predicts Recurrence of Patients with Papillary Thyroid Carcinoma and Clinically Node-Negative Lateral Neck and May Guide Extent of Initial Surgery. World J Surg 39, 194–202 (2015). https://doi.org/10.1007/s00268-014-2800-z
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DOI: https://doi.org/10.1007/s00268-014-2800-z