Advertisement

Langenbeck's Archives of Surgery

, Volume 392, Issue 4, pp 417–422 | Cite as

Microscopic regional lymph node status in papillary thyroid carcinoma with and without lymphadenopathy and its relation to outcomes

  • Nobuyuki WadaEmail author
  • Nobuyasu Suganuma
  • Hirotaka Nakayama
  • Katsuhiko Masudo
  • Yasushi Rino
  • Munetaka Masuda
  • Toshio Imada
Current Concepts in Endocrine Surgery

Abstract

Aim

The aim of this study was to evaluate microscopic nodal status in papillary thyroid carcinoma (PTC) with and without lymphadenopathy and its relation to outcomes.

Materials and methods

We retrospectively analyzed 134 patients with PTC who underwent initial thyroidectomy. Forty-two patients with lymphadenopathy underwent therapeutic modified neck dissection (MND) and 92 without lymphadenopathy underwent prophylactic MND. The frequencies, numbers, and percentages of lymph node metastasis (LNM) were determined to evaluate nodal status; then, whether each nodal status influence to outcomes was analyzed. Disease-free survival (DFS) and disease-specific survival (DSS) were assessed (Kaplan–Meier method and log-rank test).

Results

Lymphadenopathy was significantly related to local recurrence and DFS, but not DSS. The frequency (100 vs 67.4%), number (15.8 vs 2.7), and percentage (49.7 vs 17.8%) were significantly higher in patients with lymphadenopathy than in those without lymphadenopathy (p < 0.0001). Similarly, these were significantly higher in patients who developed recurrence than in those who did not. Recurrence was frequent in older patients with lymphadenopathy. The frequency, number, and percentage were also higher in older patients who developed local recurrence.

Conclusions

Lymphadenopathy and microscopic nodal status are significantly related to recurrence. Only a few nodes seem to be involved pathologically when no lymphadenopathy.

Keywords

Papillary thyroid carcinoma Lymph node metastasis Lymphadenopathy Recurrence Nodal status 

References

  1. 1.
    Noguchi S, Murakami N, Yamashita H, Toda M, Kawamoto H (1998) Papillary thyroid carcinoma: modified radical neck dissection improves prognosis. Arch Surg 133:276–280PubMedCrossRefGoogle Scholar
  2. 2.
    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 98:31–40PubMedCrossRefGoogle Scholar
  3. 3.
    Lundgren CI, Hall P, Dickman PW, Zedenius J (2006) Clinically significant prognostic factors for differentiated thyroid carcinoma. Cancer 106:524–531PubMedCrossRefGoogle Scholar
  4. 4.
    Machens A, Holzhausen HJ, Lautenschlager C, Thanh PN, Dralle H (2003) Enhancement of lymph node metastasis and distant metastasis of thyroid carcinoma. Cancer 98:712–719PubMedCrossRefGoogle Scholar
  5. 5.
    Ducci M, Appetecchia M, Marzetti M (1997) Neck dissection for surgical treatment of lymphnode metastasis in papillary thyroid carcinoma. J Exp Clin Cancer Res 16:333–335PubMedGoogle Scholar
  6. 6.
    Musacchio MJ, Kim AW, Vijungco JD, Prinz RA (2003) Greater local recurrence occurs with “berry picking” than neck dissection in thyroid cancer. Am Surg 69:191–196PubMedGoogle Scholar
  7. 7.
    Beasley NJ, Lee J, Eski S, Walfish P, Witterick I, Freeman JL (2002) Impact of nodal metastases on prognosis in patients with well-differentiated thyroid cancer. Arch Otolaryngol Head Neck Surg 128:825–828PubMedGoogle Scholar
  8. 8.
    Mazzaferri EL, Young RL (1981) Papillary thyroid carcinoma: a 10 year follow-up report of the impact of therapy in 576 patients. Am J Med 70:511–518PubMedCrossRefGoogle Scholar
  9. 9.
    Sivanandan R, Soo KC (2001) Pattern of cervical lymph node metastases from papillary carcinoma of the thyroid. Br J Surg 88:1241–1244PubMedCrossRefGoogle Scholar
  10. 10.
    Kupferman ME, Patterson M, Mandel SJ, LiVolsi V, Weber RS (2004) Patterns of lateral neck metastasis in papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg 130:857–860PubMedCrossRefGoogle Scholar
  11. 11.
    McHenry CR, Rosen IB, Walfish PG (1991) Prospective management of nodal metastases in differentiated thyroid cancer. Am J Surg 162:353–356PubMedCrossRefGoogle Scholar
  12. 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 237:399–407PubMedCrossRefGoogle Scholar
  13. 13.
    Borson-Chazot F, Causeret S, Lifante JC, Augros M, Berger N, Peix JL (2004) Predictive factors for recurrence from a series of 74 children and adolescents with differentiated thyroid cancer. World J Surg 28:1088–1092PubMedCrossRefGoogle Scholar
  14. 14.
    Leboulleux S, Rubino C, Baudin E, Caillou B, Hartl DM, Bidart JM, Travagli JP, Schlumberger M (2005) Prognostic factors for persistent or recurrent disease of papillary thyroid carcinoma with neck lymph node metastases and/or tumor extension beyond the thyroid capsule at initial diagnosis. J Clin Endocrinol Metab 90:5723–5729PubMedCrossRefGoogle Scholar
  15. 15.
    Scheumann GF, Gimm O, Wegener G, Hundeshagen H, Dralle H (1994) Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer. World J Surg 18:559–567PubMedCrossRefGoogle Scholar
  16. 16.
    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 135:139–148PubMedCrossRefGoogle Scholar
  17. 17.
    Sugino K, Kure Y, Iwasaki H, Ozaki O, Mimura T, Matsumoto A, Ito K (1995) Metastases to the regional lymph nodes, lymph node recurrence, and distant metastases in nonadvanced papillary thyroid carcinoma. Surg Today 25:324–328PubMedCrossRefGoogle Scholar
  18. 18.
    Hughes CJ, Shaha AR, Shah JP, Loree TR (1996) Impact of lymph node metastasis in differentiated carcinoma of the thyroid: a matched-pair analysis. Head Neck 18:127–132PubMedCrossRefGoogle Scholar
  19. 19.
    Hay ID, Bergstralh EJ, Grant CS, McIver B, Thompson GB, van Heerden JA, Goellner JR (1999) Impact of primary surgery on outcome in 300 patients with pathologic tumor-node-metastasis stage III papillary thyroid carcinoma treated at one institution from 1940 through 1989. Surgery 126:1173–1181PubMedCrossRefGoogle Scholar
  20. 20.
    Gimm O, Rath FW, Dralle H (1998) Pattern of lymph node metastases in papillary thyroid carcinoma. Br J Surg 85:252–254PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Nobuyuki Wada
    • 1
    Email author
  • Nobuyasu Suganuma
    • 1
  • Hirotaka Nakayama
    • 1
  • Katsuhiko Masudo
    • 1
  • Yasushi Rino
    • 1
  • Munetaka Masuda
    • 1
  • Toshio Imada
    • 1
  1. 1.Department of General SurgeryYokohama City University Hospital and Medical CenterYokohama CityJapan

Personalised recommendations