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Clinicopathological Significance of Papillary Thyroid Carcinoma Located in the Isthmus: A Meta-Analysis

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Abstract

Background

The thyroid isthmus is located directly anterior to the trachea and is covered by the strap muscles. Several studies have suggested that papillary thyroid carcinoma (PTC) in the isthmus is more aggressive and is associated with a poor prognosis. The purpose of this meta-analysis was to assess the clinicopathological characteristics and recurrence rates of PTC in the isthmus compared to PTC at other sites.

Methods

Relevant articles were obtained by searching the PubMed database. A meta-analysis was performed using 11 eligible studies.

Results

The rate of extrathyroidal extension was 0.502 (95% confidence interval [CI]: 0.239–0.764) and 0.454 (95% CI: 0.331–0.582) for isthmus PTC and PTC at other site, respectively; however, the difference in the rates was not statistically significant. Lymphovascular invasion did not significantly differ between isthmus PTC (0.179 [95% CI: 0.102–0.297]) and PTC at other sites (0.114 [95% CI: 0.066–0.188]). The rate of central lymph node (LN) metastasis was significantly higher in isthmus PTC (0.527 [95% CI: 0.435–0.617]) than in PTC at other sites (0.352 [95% CI: 0.280–0.432]). No significant difference was observed between the two groups in terms of lateral cervical LN metastasis rate. Isthmus PTC was more likely to have a prominent recurrence rate (0.046 [95% CI: 0.022–0.094]) than PTC at other sites (0.010 [95% CI: 0.001–0.070]); however, the difference was not statistically significant (because of the small number of included studies).

Conclusions

The results of this meta-analysis indicated that isthmus PTC was associated with an increased risk of central LN metastasis. Isthmus PTC seems to have a slightly higher recurrence rate than PTC at other sites. Therefore, considering the potential of the isthmus location as an unfavorable factor, more attention should be focused on isthmus PTC, and a more aggressive approach such as prophylactic central LN dissection might provide better outcomes in PTC management.

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Acknowledgements

This study was supported by research funds from Chosun University Hospital, 2019.

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Author notes

  1. Young Sang Lyu and Jung Soo Pyo contributed equally to this study.

Authors and Affiliations

  1. Department of Endocrinology and Metabolism, Chosun University Hospital, Chosun University School of Medicine, 588 Seoseok-Dong, Dong-Gu, Gwangju, Republic of Korea

    Young Sang Lyu, Sang Yong Kim & Jin Hwa Kim

  2. Department of Pathology, Eulji University School of Medicine, Daejeon, Republic of Korea

    Jung Soo Pyo

  3. Department of Urology, Chosun University Hospital, Chosun University School of Medicine, Gwangju, Republic of Korea

    Won Jin Cho

  4. Study Group for Meta-Analysis, Chosun University Hospital, Chosun University School of Medicine, Gwangju, Republic of Korea

    Young Sang Lyu, Won Jin Cho & Jin Hwa Kim

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  1. Young Sang Lyu
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Correspondence to Jin Hwa Kim.

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Lyu, Y.S., Pyo, J.S., Cho, W.J. et al. Clinicopathological Significance of Papillary Thyroid Carcinoma Located in the Isthmus: A Meta-Analysis. World J Surg 45, 2759–2768 (2021). https://doi.org/10.1007/s00268-021-06178-1

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  • DOI: https://doi.org/10.1007/s00268-021-06178-1

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