Advertisement

Amalgamation of Central Lymph Node Dissection in Papillary Thyroid Carcinoma: Study from South Indian Population

  • Girish Mysore SureshEmail author
  • Rajshekar Halkud
  • Ravi Arjunan
  • C. Ramachandra
  • Syed Altaf
  • Durgesh Pandey
  • S. Krishnamurthy
Original Article
  • 16 Downloads

Abstract

The aim of this study was to evaluate the correlation between central lymph node (CLN) metastasis and Clinicopathological characteristics of papillary thyroid cancer (PTC). In addition, we investigated the incidence and risk factors for ipsilateral and contra lateral CLN metastasis in unilateral PTC and the appropriate surgical extent for CLN dissection. A prospective study of 143 patients with unilateral PTC who underwent total thyroidectomy and prophylactic bilateral CLN dissection was conducted. Of 143 patients, 58 had CLN metastases. The rate of CLN metastasis was considerably higher in cases of maximal tumor size > 1 cm (P < 0.0001; OR 5.81). Ipsilateral CLN metastasis was detected in 41% of cases of unilateral PTC, and contra lateral CLN metastases was found in 14% of cases where as bilateral CLN metastases in 8% of cases. The rate of contra lateral CLN metastasis was considerably higher in cases of PTC with a large tumor size (≥ 1 cm) (P = 0.0003; OR = 0.144) and with ipsilateral CLN metastasis (P = 0.0002; OR 0.12). Tumor size > 1 cm was independent risk factors for CLN metastasis. Maximal tumor size > 1 cm and presence of ipsilateral CLN macro metastasis were independent risk factors for contra lateral CLN metastasis. Therefore, both ipsilateral and contra lateral CLN dissections should be considered for unilateral PTC with a maximal tumor size > 1 cm or presence of ipsilateral CLN macro metastasis.

Keywords

Lymph node metastasis Papillary thyroid cancer Central lymph node dissection 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Unnikrishnan AG, Menon UV (2011) Thyroid disorders in India: an epidemiological perspective. Indian J Endocr Metab 15:S78–S81CrossRefGoogle Scholar
  2. 2.
    Lundgren CI, Hall P, Dickman PW, Zedenius J (2006) Clinically significant prognostic factors for differentiated thyroid carcinoma: a population-based, nested casecontrol study. Cancer 106:524–531CrossRefGoogle Scholar
  3. 3.
    Lim YC, Choi EC, Yoon YH et al (2009) Central lymph node metastases in unilateral papillary thyroid microcarcinoma. Br J Surg 96:253–257CrossRefGoogle Scholar
  4. 4.
    Nam IC, Park JO, Joo YH et al (2013) Pattern and predictive factors of regional lymph node metastasis in papillary thyroid carcinoma: a prospective study. Head Neck 35:40–45CrossRefGoogle Scholar
  5. 5.
    Nixon IJ, Ganly I, Patel SG et al (2013) Observation of clinically negative central compartment lymph nodes in papillary thyroid carcinoma. Surgery 154:1166–1172 (discussion 1172-3) CrossRefGoogle Scholar
  6. 6.
    Kim WW, Park HY, Jung JH (2013) Surgical extent of central lymph node dissection in clinically node-negative papillary thyroid cancer. Head Neck 35:1616–1620CrossRefGoogle Scholar
  7. 7.
    Ahn BH, Kim JR, Jeong HC, Lee JS, Chang ES, Kim YH (2015) Predictive factors of central lymph node metastasis in papillary thyroid carcinoma. Ann Surg Treat Res 88(2):63–68CrossRefGoogle Scholar
  8. 8.
    Gaddis ML, Gaddis GM (1990) Introduction to biostatistics: part 4, statistical inference techniques in hypothesis testing. Ann Emerg Med 19:820–825CrossRefGoogle Scholar
  9. 9.
    Patra P (2012) Sample size in clinical research, the number we need. Int J Med Sci Public Health 1:5–9Google Scholar
  10. 10.
    American Thyroid Association (ATA) (2009) Guidelines taskforce on thyroid nodules and differentiated thyroid cancer, Cooper DS, Doherty GM, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214CrossRefGoogle Scholar
  11. 11.
    Nixon IJ, Ganly I, Patel SG et al (2013) Observation of clinically negative central compartment lymph nodes in papillary thyroid carcinoma. Surgery 154:1166–1172 (discussion 1172-3) CrossRefGoogle Scholar
  12. 12.
    Raffaelli M, De Crea C, Sessa L et al (2012) Prospective evaluation of total thyroidectomy versus ipsilateral versus bilateral central neck dissection in patients with clinically node-negative papillary thyroid carcinoma. Surgery 152:957–964CrossRefGoogle Scholar
  13. 13.
    Chisholm EJ, Kulinskaya E, Tolley NS (2009) Systematic review and meta-analysis of the adverse effects of thyroidectomy combined with central neck dissection as compared with thyroidectomy alone. Laryngoscope 119:1135–1139CrossRefGoogle Scholar
  14. 14.
    Rotstein L (2009) The role of lymphadenectomy in the management of papillary carcinoma of the thyroid. J Surg Oncol 99:186–188CrossRefGoogle Scholar
  15. 15.
    Lee KE, Chung IY, Kang E et al (2013) Ipsilateral and contralateral central lymph node metastasis in papillary thyroid cancer: patterns and predictive factors of nodal metastasis. Head Neck 35:672–676CrossRefGoogle Scholar
  16. 16.
    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 249:840–844CrossRefGoogle Scholar
  17. 17.
    Popadich A, Levin O, Lee JC et al (2011) A multicenter cohort study of total thyroidectomy and routine central lymph node dissection for cN0 papillary thyroid cancer. Surgery 150:1048–1057CrossRefGoogle Scholar
  18. 18.
    Roh JL, Kim JM, Park CI (2011) Central lymph node metastasis of unilateral papillary thyroid carcinoma: patterns and factors predictive of nodal metastasis, morbidity, and recurrence. Ann Surg Oncol 18:2245–2250CrossRefGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2019

Authors and Affiliations

  1. 1.Department of Surgical OncologyKidwai Memorial Institute of OncologyBengaluruIndia
  2. 2.Department Head and Neck OncologyKidwai Memorial Institute of OncologyBengaluruIndia

Personalised recommendations