Skip to main content
SpringerLink
Log in

Papillary Thyroid Cancers of the Thyroid Isthmus: The Pattern of Nodal Metastasis and the Significance of Extrathyroidal Extension

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Cancers of the thyroid isthmus are less frequent compared with the lobar cancers yet have their own unique clinicopathological characteristics. Herein, we sought to examine the isthmic papillary thyroid carcinomas (PTCs) for the pattern of and risk factors for nodal metastasis and the significance of extrathyroidal extension (ETE).

Methods

The medical records of 3138 patients diagnosed with solitary PTC who had undergone surgery were retrospectively reviewed. Of these, 122 isthmic PTCs were matched to common lobar PTCs at a ratio of 1:3 for age, sex, and nodule size. Patient demographics, surgical findings, and pathology reports were analyzed.

Results

Isthmic PTCs comprised 4.6% of all PTCs and had more lymphatic invasion (22.1% vs. 13.4%, p = 0.021), ETE (73.0% vs. 57.1%, p = 0.002), and perithyroidal and prelaryngeal node metastasis (18.0% vs. 9.0%, p = 0.006) compared with lobar PTCs. However, there were no significant differences in the rate of central and lateral node metastasis between the two groups. ETE was identified not to be a risk factor for isthmic PTCs for central and lateral node metastasis, in contrast to lobar PTCs in which ETE was a significant risk factor (odds ratio 3.18, 95% confidence interval [CI] 1.89–5.34; and 4.72, 95% CI 1.04–21.41).

Conclusion

The rates of central and lateral node metastasis of isthmic PTCs are comparable with that of lobar PTCs despite a higher rate of ETE in the isthmic counterpart. Although the extent of surgery for isthmic PTCs remains to be investigated, careful dissection of perithyroidal and prelaryngeal nodes may be necessary for isthmic PTCs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Hahn SY, Han BK, Ko EY, Shin JH, Ko ES. Ultrasound findings of papillary thyroid carcinoma originating in the isthmus: comparison with lobe-originating papillary thyroid carcinoma. AJR Am J Roentgenol. 2014;203(3):637–42.

    Article  Google Scholar 

  2. Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association (ATA) guidelines taskforce on thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11):1167–214.

    Article  Google Scholar 

  3. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1–133.

    Article  Google Scholar 

  4. Watkinson JC. The British Thyroid Association guidelines for the management of thyroid cancer in adults. Nucl Med Commun. 2004;25(9):897–900.

    Article  Google Scholar 

  5. Filetti S, Durante C, Hartl D, et al. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2019;30(12):1856–83.

    Article  CAS  Google Scholar 

  6. Goldfarb M, Rodgers SS, Lew JI. Appropriate surgical procedure for dominant thyroid nodules of the isthmus 1 cm or larger. Arch Surg. 2012;147(9):881–4.

    Article  Google Scholar 

  7. Maser C, Donovan P, Udelsman R. Thyroid isthmusectomy: a rarely used but simple, safe, and efficacious operation. J Am Coll Surg. 2007;204(3):512–4.

    Article  Google Scholar 

  8. Nixon IJ, Palmer FL, Whitcher MM, et al. Thyroid isthmusectomy for well-differentiated thyroid cancer. Ann Surg Oncol. 2011;18(3):767–70.

    Article  Google Scholar 

  9. Pérez-Ruiz L, Ros-López S, Gudelis M, Latasa-Gimeno JA, Artigas-Marco C, Pelayo-Salas A. Isthmectomy: a conservative operation for solitary nodule of the thyroid isthmus. Acta Chir Belg. 2016;108(6):699–701.

    Article  Google Scholar 

  10. Skilbeck C, Leslie A, Simo R. Thyroid isthmusectomy: a critical appraisal. J Laryngol Otol. 2007;121(10):986–9.

    Article  CAS  Google Scholar 

  11. Vasileiadis I, Boutzios G, Karalaki M, Misiakos E, Karatzas T. Papillary thyroid carcinoma of the isthmus: total thyroidectomy or isthmusectomy? Am J Surg. 2018;216(1):135–9.

    Article  Google Scholar 

  12. Wang J, Sun H, Gao L, Xie L, Cai X. Evaluation of thyroid isthmusectomy as a potential treatment for papillary thyroid carcinoma limited to the isthmus: a clinical study of 73 patients. Head Neck. 2016;38 Suppl 1:E1510–4.

    Article  Google Scholar 

  13. Yi KI, Wang SG, Lee BJ, et al. The factors involved in bilateral central lymph node metastasis of isthmus papillary thyroid cancer. Korean J Otorhinolaryngol-Head Neck Surg. 2017;60(3):125–34.

    Article  Google Scholar 

  14. Li G, Lei J, Peng Q, et al. Lymph node metastasis characteristics of papillary thyroid carcinoma located in the isthmus: a single-center analysis. Medicine. 2017;96(24):e7143.

    Article  Google Scholar 

  15. Edge SB, Byrd DR, Carducci MA, Compton CC, Fritz AG, Greene FL. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.

    Google Scholar 

  16. Lee YS, Jeong JJ, Nam KH, Chung WY, Chang HS, Park CS. Papillary carcinoma located in the thyroid isthmus. World J Surg. 2010;34(1):36.

    Article  Google Scholar 

  17. Sugenoya A, Shingu K, Kobayashi S, et al. Surgical strategies for differentiated carcinoma of the thyroid isthmus. Head Neck. 1993;15(2):158–60.

    Article  CAS  Google Scholar 

  18. Nam IC, Choi H, Kim ES, Mo EY, Park YH, Sun DI. Characteristics of thyroid nodules causing globus symptoms. Eur Arch Otorhinolaryngol. 2015;272(5):1181–8.

    Article  Google Scholar 

  19. Karatzas T, Charitoudis G, Vasileiadis D, Kapetanakis S, Vasileiadis I. Surgical treatment for dominant malignant nodules of the isthmus of the thyroid gland: a case control study. Int J Surg. 2015;18:64–8.

    Article  Google Scholar 

  20. So YK, Kim MW, Son YI. Multifocality and bilaterality of papillary thyroid microcarcinoma. Clin Exp Otorhinolaryngol. 2015;8(2):174.

    Article  Google Scholar 

  21. Song CM, Lee DW, Ji YB, Jeong JH, Park JH, Tae K. Frequency and pattern of central lymph node metastasis in papillary carcinoma of the thyroid isthmus. Head Neck. 2016;38(S1):E412–6.

    Article  Google Scholar 

  22. Mete O, Rotstein L, Asa SL. Controversies in thyroid pathology: thyroid capsule invasion and extrathyroidal extension. Ann Surg Oncol. 2010;17(2):386–91.

    Article  Google Scholar 

  23. Shah JP, Loree TR, Dharker D, Strong EW, Begg C, Vlamis V. Prognostic factors in differentiated carcinoma of the thyroid gland. Am J Surg. 1992;164(6):658–61.

    Article  CAS  Google Scholar 

  24. Andersen PE, Kinsella J, Loree TR, Shaha AR, Shah JP. Differentiated carcinoma of the thyroid with extrathyroidal extension. Am J Surg. 1995;170(5):467–70.

    Article  CAS  Google Scholar 

  25. Sugitani I, Toda K, Yamada K, Yamamoto N, Ikenaga M, Fujimoto Y. Three distinctly different kinds of papillary thyroid microcarcinoma should be recognized: our treatment strategies and outcomes. World J Surg. 2010;34(6):1222–31.

    Article  Google Scholar 

  26. Yin DT, Yu K, Lu R-Q, Li X, Xu J, Lei M. Prognostic impact of minimal extrathyroidal extension in papillary thyroid carcinoma. Medicine. 2016;95(52):e5794.

    Article  Google Scholar 

  27. Coburn MC, Wanebo HJ. Prognostic factors and management considerations in patients with cervical metastases of thyroid cancer. Am J Surg. 1992;164(6):671–6.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

    Jungirl Seok MD, Young Ho Jung MD, PhD & Woo-Jin Jeong MD, PhD

  2. Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea

    Jungirl Seok MD & Soon-Hyun Ahn MD, PhD

  3. Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

    June Young Choi MD, PhD & Hyeong Won Yu MD, PhD

Authors
  1. Jungirl Seok MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. June Young Choi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hyeong Won Yu MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Young Ho Jung MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Soon-Hyun Ahn MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Woo-Jin Jeong MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Woo-Jin Jeong MD, PhD.

Ethics declarations

Disclosures

Jungirl Seok, June Young Choi, Hyeong Won Yu, Young Ho Jung, Soon-Hyun Ahn, and Woo-Jin Jeong have no disclosures to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 19 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Seok, J., Choi, J.Y., Yu, H.W. et al. Papillary Thyroid Cancers of the Thyroid Isthmus: The Pattern of Nodal Metastasis and the Significance of Extrathyroidal Extension. Ann Surg Oncol 27, 1937–1944 (2020). https://doi.org/10.1245/s10434-020-08215-0

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-020-08215-0

Search

Navigation