Annals of Surgical Oncology

, Volume 24, Issue 2, pp 460–468 | Cite as

Extent of Extrathyroidal Extension as a Significant Predictor of Nodal Metastasis and Extranodal Extension in Patients with Papillary Thyroid Carcinoma

  • Ji Won Kim
  • Jong-Lyel RohEmail author
  • Gyungyup Gong
  • Kyung-Ja Cho
  • Seung-Ho Choi
  • Soon Yuhl Nam
  • Sang Yoon Kim
Endocrine Tumors



Extrathyroidal extension (ETE) and extranodal extension (ENE) indicate poor prognosis for patients with papillary thyroid carcinoma (PTC). The relationships among ETE, ENE, and nodal metastasis (N1) have not been thoroughly studied. In this study, we examined the relationships among the extent of ETE, N1, ENE, and posttreatment recurrence in patients with PTC.


This study enrolled 1693 consecutive patients with previously untreated PTC who underwent thyroidectomy between 2006 and 2009. The extent of ETE was graded based on intraoperative and pathological findings, and central and lateral neck (N1b) nodal metastases and ENE were pathologically determined. Univariate and multivariate analyses were used to identify the association of clinicopathological factors with recurrence-free survival (RFS) and to define the relationships among the extent of ETE, N1, and ENE.


Of 1693 patients, 1087 (64.2 %) had ETE and 201 (11.9 %) had ENE. Pathologically positive lymph nodes were found in 783 patients (46.2 %), of whom 236 (30.1 %) had N1b. During the median follow-up of 86 months, 90 (5.3 %) patients had recurrences. Multivariate analyses showed that multifocality, ETE, T and N classification, the risk of structural recurrence proposed by the American Thyroid Association, and ENE were independent variables for RFS (P < .05). Patients with macroscopic ETE had a 13-fold increased risk of recurrence, and ETE had significant relationships with N1, N1b, and ENE (all P < .001).


Local extension, nodal involvement, and ENE contribute to posttreatment recurrence of PTC. Macroscopic ETE predicts nodal metastasis and ENE, which are adverse pathologic features.


Papillary Thyroid Carcinoma Lymph Node Ratio Differentiate Thyroid Cancer Lateral Neck Extrathyroidal Extension 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This study was supported by a Grant (No. 2015R1A2A1A15054540) from the Basic Science Research Program through the National Research Foundation of Korea (NRF), Ministry of Science, ICT, and Future Planning and a Grant (No. HI15C2920) from the Korean Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), Ministry of Health & Welfare, Seoul, Republic of Korea (J.L. Roh).


The authors have declared no conflicts of interest.

Supplementary material

10434_2016_5594_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 15 kb)


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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Ji Won Kim
    • 1
  • Jong-Lyel Roh
    • 1
    Email author
  • Gyungyup Gong
    • 2
  • Kyung-Ja Cho
    • 2
  • Seung-Ho Choi
    • 1
  • Soon Yuhl Nam
    • 1
  • Sang Yoon Kim
    • 1
  1. 1.Department of Otolaryngology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  2. 2.Department of Pathology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea

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