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Predicting the factors associated with central lymph node metastasis in clinical node-negative (cN0) papillary thyroid microcarcinoma

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Abstract

Purpose

The aim of the present study was to investigate the risk factors associated with central lymph node metastasis (CLNM) in papillary thyroid microcarcinoma (PTMC).

Methods

A total of 553 patients with PTMC confirmed by histological examination, who underwent thyroidectomy and central neck dissection (CND), were enrolled. The clinicopathological and ultrasonographic features from the patients were analyzed retrospectively.

Results

PTMC patient age, Hashimoto thyroiditis (HT), tumor location, extrathyroidal extension (ETE), microcalcification and higher E values were correlated with the incidence of CLNM. Multivariate logistic regression analysis showed that age, HT, tumor location, ETE and Emax were related to the extent of CLNM. Chi-squared automatic interaction detection (CHAID) classification tree model showed that patients with tumor in upper/lower third combined ETE had a high risk of CLNM. Furthermore, cN0 PTMC patients with age ≤ 45 years and ETE had more extensive CLNM.

Conclusion

Our observations could be helpful for the assessment of prognostic factors of PTMC patients with CLNM.

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References

  1. Hay ID, Grant CS, van Heerden JA, Goellner JR, Ebersold JR, Bergstralh EJ (1992) Papillary thyroid microcarcinoma: a study of 535 cases observed in a 50-year period. Surgery 112(6):1139–1146 (discussion 1146–1137)

    PubMed  CAS  Google Scholar 

  2. Baudin E, Travagli JP, Ropers J, Mancusi F, Bruno-Bossio G, Caillou B, Cailleux AF, Lumbroso JD, Parmentier C, Schlumberger M (1998) Microcarcinoma of the thyroid gland: the Gustave-Roussy Institute experience. Cancer 83(3):553–559. https://doi.org/10.1002/(SICI)1097-0142(19980801)83:3%3c553:AID-CNCR25%3e3.0.CO;2-U

    Article  PubMed  CAS  Google Scholar 

  3. Mehanna H, Al-Maqbili T, Carter B, Martin E, Campain N, Watkinson J, McCabe C, Boelaert K, Franklyn JA (2014) Differences in the recurrence and mortality outcomes rates of incidental and nonincidental papillary thyroid microcarcinoma: a systematic review and meta-analysis of 21 329 person-years of follow-up. J Clin Endocrinol Metab 99(8):2834–2843. https://doi.org/10.1210/jc.2013-2118

    Article  PubMed  CAS  Google Scholar 

  4. Chow SM, Law SC, Chan JK, Au SK, Yau S, Lau WH (2003) Papillary microcarcinoma of the thyroid-Prognostic significance of lymph node metastasis and multifocality. Cancer 98(1):31–40. https://doi.org/10.1002/cncr.11442

    Article  PubMed  Google Scholar 

  5. Xu JM, Xu XH, Xu HX, Zhang YF, Guo LH, Liu LN, Liu C, Bo XW, Qu S, Xing M, Li XL (2016) Prediction of cervical lymph node metastasis in patients with papillary thyroid cancer using combined conventional ultrasound, strain elastography, and acoustic radiation force impulse (ARFI) elastography. Eur Radiol 26(8):2611–2622. https://doi.org/10.1007/s00330-015-4088-2

    Article  PubMed  Google Scholar 

  6. Kwak JY, Kim EK, Youk JH, Kim MJ, Son EJ, Choi SH, Oh KK (2008) Extrathyroid extension of well-differentiated papillary thyroid microcarcinoma on US. Thyroid 18(6):609–614. https://doi.org/10.1089/thy.2007.0345

    Article  PubMed  Google Scholar 

  7. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M (2016) 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 26(1):1–133. https://doi.org/10.1089/thy.2015.0020

    Article  PubMed  PubMed Central  Google Scholar 

  8. Zhang L, Wei WJ, Ji QH, Zhu YX, Wang ZY, Wang Y, Huang CP, Shen Q, Li DS, Wu Y (2012) Risk factors for neck nodal metastasis in papillary thyroid microcarcinoma: a study of 1066 patients. J Clin Endocrinol Metab 97(4):1250–1257. https://doi.org/10.1210/jc.2011-1546

    Article  PubMed  CAS  Google Scholar 

  9. Jin WX, Ye DR, Sun YH, Zhou XF, Wang OC, Zhang XH, Cai YF (2018) Prediction of central lymph node metastasis in papillary thyroid microcarcinoma according to clinicopathologic factors and thyroid nodule sonographic features: a case-control study. Cancer Manag Res 10:3237–3243. https://doi.org/10.2147/CMAR.S169741

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  10. Zeng RC, Li Q, Lin KL, Zhang W, Gao EL, Huang GL, Zhang XH, Zheng MH (2012) Predicting the factors of lateral lymph node metastasis in papillary microcarcinoma of the thyroid in eastern China. Clin Transl Oncol 14(11):842–847. https://doi.org/10.1007/s12094-012-0875-2

    Article  PubMed  Google Scholar 

  11. Cho SY, Lee TH, Ku YH, Kim HI, Lee GH, Kim MJ (2015) Central lymph node metastasis in papillary thyroid microcarcinoma can be stratified according to the number, the size of metastatic foci, and the presence of desmoplasia. Surgery 157(1):111–118. https://doi.org/10.1016/j.surg.2014.05.023

    Article  PubMed  Google Scholar 

  12. Wada N, Duh QY, Sugino K, Iwasaki H, Kameyama K, Mimura T, Ito K, Takami H, Takanashi Y (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):399–407. https://doi.org/10.1097/01.SLA.0000055273.58908.19

    Article  PubMed  PubMed Central  Google Scholar 

  13. Roh JL, Park JY, Park CI (2007) Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg 245(4):604–610. https://doi.org/10.1097/01.sla.0000250451.59685.67

    Article  PubMed  PubMed Central  Google Scholar 

  14. Lee YS, Nam KH, Chung WY, Chang HS, Park CS (2010) Postoperative complications of thyroid cancer in a single center experience. J Korean Med Sci 25(4):541–545. https://doi.org/10.3346/jkms.2010.25.4.541

    Article  PubMed  PubMed Central  Google Scholar 

  15. Cavicchi O, Piccin O, Caliceti U, Cataldis AD, Pasquali R, Ceroni AR (2007) Transient hypoparathyroidism following thyroidectomy: a prospective study and multivariate analysis of 604 consecutive patients. Otolaryngol Head Neck Surg 137(4):654–658. https://doi.org/10.1016/j.otohns.2007.03.001

    Article  PubMed  Google Scholar 

  16. Ito Y, Kobayashi K, Tomoda C, Uruno T, Takamura Y, Miya A, Matsuzuka F, Kuma K, Miyauchi A (2005) Ill-defined edge on ultrasonographic examination can be a marker of aggressive characteristic of papillary thyroid microcarcinoma. World J Surg 29(8):1007–1011. https://doi.org/10.1007/s00268-005-7834-9

    Article  PubMed  Google Scholar 

  17. Dailey ME, Lindsay S, Skahen R (1955) Relation of thyroid neoplasms to Hashimoto disease of the thyroid gland. AMA Arch Surg 70(2):291–297. https://doi.org/10.1001/archsurg.1955.01270080137023

    Article  PubMed  CAS  Google Scholar 

  18. Calogero C, Luigi S, Giuseppa G, Salvatore F, Adriana T, Salvatore V, Stefania L, Mario AL (2005) Hashimoto thyroiditis coexistent with papillary thyroid carcinoma. Am Surg 71(10):874–878

    Google Scholar 

  19. Zhu F, Shen YB, Li FQ, Fang Y, Hu L, Wu YJ (2016) The Effects of Hashimoto thyroiditis on lymph node metastases in unifocal and multifocal papillary thyroid carcinoma: a retrospective Chinese cohort study. Medicine (Baltimore) 95(6):e2674. https://doi.org/10.1097/MD.0000000000002674

    Article  CAS  Google Scholar 

  20. Qu N, Zhang L, Lin DZ, Ji QH, Zhu YX, Wang Y (2016) The impact of coexistent Hashimoto’s thyroiditis on lymph node metastasis and prognosis in papillary thyroid microcarcinoma. Tumour Biol 37(6):7685–7692. https://doi.org/10.1007/s13277-015-4534-4

    Article  PubMed  CAS  Google Scholar 

  21. Jara SM, Carson KA, Pai SI, Agrawal N, Richmon JD, Prescott JD, Dackiw A, Zeiger MA, Bishop JA, Tufano RP (2013) The relationship between chronic lymphocytic thyroiditis and central neck lymph node metastasis in North American patients with papillary thyroid carcinoma. Surgery 154(6):1272–1282. https://doi.org/10.1016/j.surg.2013.07.021

    Article  PubMed  Google Scholar 

  22. Moon HJ, Sung JM, Kim E, Yoon JH, Youk JH, Kwak JY (2012) Diagnostic performance of gray-scale us and elastography in solid thyroid nodules. Radiology 262(3):1002–1013. https://doi.org/10.1148/radiol.11110839

    Article  PubMed  Google Scholar 

  23. Park AY, Kim JA, Son EJ, Youk JH (2016) Shear-wave elastography for papillary thyroid carcinoma can improve prediction of cervical lymph node metastasis. Ann Surg Oncol 23(Suppl 5):722–729. https://doi.org/10.1245/s10434-016-5572-x

    Article  PubMed  Google Scholar 

  24. Jung WS, Kim JA, Son EJ, Youk JH, Park CS (2015) Shear wave elastography in evaluation of cervical lymph node metastasis of papillary thyroid carcinoma: elasticity index as a prognostic implication. Ann Surg Oncol 22(1):111–116. https://doi.org/10.1245/s10434-014-3627-4

    Article  PubMed  Google Scholar 

  25. Hong YR, Yan CX, Mo GQ, Luo ZY, Zhang Y, Wang Y, Huang PT (2015) Conventional US, elastography, and contrast enhanced US features of papillary thyroid microcarcinoma predict central compartment lymph node metastases. Sci Rep 5(2–3):7748. https://doi.org/10.1038/srep07748

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. Levental KR, Hongmei Y, Laura K, Lakins JN, Mikala E, Erler JT, Fong SFT, Katalin C, Amato G, Wolfgang W (2009) Matrix crosslinking forces tumor progression by enhancing integrin signaling. Cell 139(5):891–906. https://doi.org/10.1016/j.cell.2009.10.027

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  27. Pengfei L, Weaver VM, Zena W (2012) The extracellular matrix: a dynamic niche in cancer progression. J Cell Biol 196(4):395–406. https://doi.org/10.1083/jcb.201102147

    Article  CAS  Google Scholar 

  28. Oh HS, Park S, Kim M, Kwon H, Song E, Sung TY, Lee YM, Kim WG, Kim TY, Shong YK et al (2017) Young age and male sex are predictors of large-volume central neck lymph node metastasis in clinical N0 papillary thyroid microcarcinomas. Thyroid 27(10):1285–1290. https://doi.org/10.1089/thy.2017.0250

    Article  PubMed  CAS  Google Scholar 

  29. Siddiqui S, White MG, Antic T, Grogan RH, Angelos P, Kaplan EL, Cipriani NA (2016) Clinical and pathologic predictors of lymph node metastasis and recurrence in papillary thyroid microcarcinoma. Thyroid 26(6):807–815. https://doi.org/10.1089/thy.2015.0429

    Article  PubMed  CAS  Google Scholar 

  30. Moon HJ, Kim EK, Chung WY, Yoon JH, Kwak JY (2011) Minimal extrathyroidal extension in patients with papillary thyroid microcarcinoma: is it a real prognostic factor? Ann Surg Oncol 18(7):1916–1923. https://doi.org/10.1245/s10434-011-1556-z

    Article  PubMed  Google Scholar 

  31. Sugitani I, Kasai N, Fujimoto Y, Yanagisawa A (2004) A novel classification system for patients with PTC: addition of the new variables of large (3 cm or greater) nodal metastases and reclassification during the follow-up period. Surgery 135(2):139–148. https://doi.org/10.1016/s0039-6060(03)00384-2

    Article  PubMed  Google Scholar 

  32. Ito Y, Tomoda C, Uruno T, Takamura Y, Miya A, Kobayashi K, Matsuzuka F, Kuma K, Miyauchi A, Ito Y (2006) Minimal extrathyroid extension does not affect the relapse-free survival of patients with papillary thyroid carcinoma measuring 4 cm or less over the age of 45 years. Surg Today 36(1):12–18. https://doi.org/10.1007/s00595-005-3090-8

    Article  PubMed  Google Scholar 

  33. Randolph GW, Duh QY, Heller KS, Livolsi VA, Mandel SJ, Steward DL, Tufano RP, Tuttle RM (2012) The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. Thyroid 22(11):1144–1152. https://doi.org/10.1089/thy.2012.0043

    Article  PubMed  Google Scholar 

  34. Wu MH, Shen WT, Gosnell J, Duh QY (2015) Prognostic significance of extranodal extension of regional lymph node metastasis in papillary thyroid cancer. Head Neck 37(9):1336–1343. https://doi.org/10.1002/hed.23747

    Article  PubMed  Google Scholar 

  35. Merima G, Tatjana P, Ivan M, Nada S, Radan D, Dusica G, Nikola B, Yasuhiro I, Igor D, Gordana P, Radan D (2017) Lymph node metastases in clinically N0 patients with papillary thyroid microcarcinomas—a single institution experience. JBUON 22(1):224–231

    Google Scholar 

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Zhang, C., Li, Bj., Liu, Z. et al. Predicting the factors associated with central lymph node metastasis in clinical node-negative (cN0) papillary thyroid microcarcinoma. Eur Arch Otorhinolaryngol 277, 1191–1198 (2020). https://doi.org/10.1007/s00405-020-05787-1

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