Correlation of Primary Tumour Size and Central Compartment Lymph Nodes Metastasis in Well Differentiated Thyroid Malignancies in a Tertiary Care Centre
- 1 Downloads
Central compartment lymph nodes are the first to be involved in thyroid carcinoma and associated with higher chances of recurrence. (1) Recurrence and revision surgery can be associated with a high risk of vocal cord paralysis and hypocalcemia. (2) However, the need for central compartment lymph nodes dissection routinely in all cases of thyroid malignancies is controversial considering the risk to recurrent laryngeal nerve and parathyroids. (3) The aim of the study was to evaluate the incidence of central compartment lymph nodes metastasis in well differentiated thyroid malignancy and their correlation with size of the primary tumour along with incidence of postoperative hypocalcemia and recurrent laryngeal nerve injury after central compartment lymph node dissection. Observational study 30 patients diagnosed as well-differentiated thyroid carcinoma after fine needle aspiration cytology and planned for total thyroidectomy and central compartment lymph node dissection in the Department of ENT at a tertiary care hospital in Mysuru were studied. After surgery, histopathological examination (HPE) of thyroid and lymph node specimen was done. Postoperatively, all patients were evaluated for hypocalcemia and recurrent laryngeal nerve injury. The incidence of central compartment lymph node metastasis after HPE was 66.6%. 80% cases with tumor size ≤ 1 cm and 64% cases having tumor size > 1 cm showed central compartment lymph node involvement. Overall Incidence of transient Hypocalcaemia was 40%. No case of recurrent laryngeal nerve palsy was observed. In well-differentiated thyroid malignancies we found a high incidence of central compartment lymph node involvement which was even higher with primary tumour of smaller size (≤ 1 cm). We did not find any incidence of permanent hypocalcemia and recurrent laryngeal nerve injury. So based on our study we emphasize on elective central compartment lymph node clearance to avoid recurrence.
KeywordsCentral compartment lymph nodes Well-differentiated thyroid malignancy Papillary thyroid carcinoma Fine needle aspiration cytology Central compartment lymph node dissection Total thyroidectomy Histopathological examination
Compliance with Ethical Standards
Conflict of interest
All the authors declare they have no competing interest.
Informed consent was obtained from all individual participants in the study.
All procedures performed in the study were in accordance with the ethical standards of the institution.
- 1.Kouser Mohammadi, Azeem Mohiyuddin SM, Prasad CSBR (2013) Evaluation of central compartment lymph nodes in well differentiated thyroid malignancies for metastasis. J Clin Biomed Sci 3(4):182–187Google Scholar
- 2.Wada N, Duh Q-Y, Sugino K, Iwasaki H, Kameyama K, Mimura T 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(3):399–407Google Scholar
- 6.Lim LHY, Soo KC, Chong YK, Gao F, Hong GS, Lim TH (2002) Well-differentiated thyroid carcinoma: factors predicting recurrence and survival. Singap Med J 43(9):457–462Google Scholar
- 9.Aydin OU, Soylu L, Ozbas S, Ilgan S, Bilezikci B, Gursoy A et al (2016) The risk of hypoparathyroidism after central compartment lymph node dissection in the surgical treatment of pT1, N0 thyroid papillary carcinoma. Eur Rev Med Pharmacol Sci 20(9):1781–1787Google Scholar
- 10.Sun Y, Lv H, Zhang S, Bai Y, Shi B (2018) Gender-specific risk of central compartment lymph node metastasis in papillary thyroid carcinoma [Internet]. In: International Journal of Endocrinology. [cited 2018 Dec 29]. Available from: https://www.hindawi.com/journals/ije/2018/6710326/. Accessed 29 Dec 2018
- 11.El Foll HA (2015) Pattern and distribution of lymph node metastases in papillary thyroid cancer. J Clin Exp Pathol [Internet]. [cited 2018 Dec 29]; 05(01). Available from: https://www.omicsonline.org/open-access/pattern-and-distribution-of-lymph-node-metastases-in-papillary-thyroid-cancer-2161-0681.1000204.php?aid=37339. Accessed 29 Dec 2018
- 16.Wang W, Gu J, Shang J, Wang K (2013) Correlation analysis on central lymph node metastasis in 276 patients with cN0 papillary thyroid carcinoma. Int J Clin Exp Pathol 6(3):510–515Google Scholar