Pattern and Predictive Factors of Neck Lymph Node Metastasis in Papillary Thyroid Carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 SHIChen-lei , SHITie-feng ,  QINHua-dong

The Fourth Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China;

Corresponding author：

QINHua-dong, Email: aitiantang83@126.com

Keywords：

Papillary thyroid carcinoma; Lymphatic metastasis; Metastasis pattern; Influence factor

DOI：

10.7507/1007-9424.20140006

Video：

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Objective To evaluate the pattern and predictive factors of regional lymph node metastasis in papillay thyroid carcinoma (PTC). Methods The clinical data of 223 patients with PTC whom suffered operation from Dec.2008 to Dec.2011 in our hospital were retrospective analyzed.The relationship among the lymph node metastasis of different area of the neck and patient's sex, age, preoperative TSH level, tumor size, multifocality, extracapsular spread, Hashimoto thyroiditis, nodular goiter, and the T classification of the tumors were analyzed. Results The univariate analysis results showed that patient's age≥45 years old and associated with nodular goiter were statistically significantly related to central lymph node metastasis (P < 0.05), for lateral lymph node metastases, the multifocality were statistically significant (P < 0.05).The multivariate analysis results showed that patient's age≥45 years old and associated with nodular goiter were protective factors for central lymph node metastasis (P < 0.05), for lateral lymph node metastasis, the multifocality was risk factor (P < 0.05).Most of the lateral lymph node metastases were confined to levels Ⅱ-Ⅳ, and the incidence of level Ⅲ was as highest as 100%.When the skip metastasis, the levels Ⅱ-Ⅳ were the transfer of high incidence areas. Conclusions When age < 45 years old of patients with PTC, the central neck dissection should be routine performed.The incidence of central lymph node metastasis will decrease if associated with nodular goiter.Because multifocality is a risk factor for lateral lymph node metastasis, careful inspection levels Ⅱ-Ⅳ should be performed during operation, espe-cially level Ⅲ lymph nodes.If skip metastasis is present, levels Ⅱ-Ⅳ dissection would be a proper treatment option.

Citation： SHIChen-lei, SHITie-feng, QINHua-dong. Pattern and Predictive Factors of Neck Lymph Node Metastasis in Papillary Thyroid Carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(1): 29-34. doi: 10.7507/1007-9424.20140006 Copy

1.	Choi Y, Park KJ, Ryu S, et al.Papillary thyroid carcinoma invo-lving cervical neck lymph nodes:correlations with lymphangiogenesis and ultrasound features[J].Endocr J, 2012, 59(10):941-948.
2.	Pelizzo MR, Boschin IM, Toniato A, et al.Papillary thyroid carc-inoma:35-year outcome and prognostic factors in 1858 patients[J].Clin Nucl Med, 2007, 32(6):440-444.
3.	Zaydfudim V, Feurer ID, Griffin MR, et al.The impact of lymph node involvement on survival in patients with papillary and follic-ular thyroid carcinoma[J].Surgery, 2008, 144(6):1070-1077.
4.	Wada N, Duh QY, Sugino K, et al.Lymph node metastasis from 259 papillary thyroid microcarcinomas:frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection[J].Ann Surg, 2003, 237(3):399-407.
5.	Moo TA, McGill J, Allendorf J, et al.Impact of prophylactic central neck lymph node dissection on early recurrence in papillary thyroid carcinoma[J].World J Surg, 2010, 34(6):1187-1191.
6.	Shindo M, Wu JC, Park EE, et al.The importance of central compartment elective lymph node excision in the staging and treatment of papillary thyroid cancer[J].Arch Otolaryngol Head Neck Surg, 2006, 132(6):650-654.
7.	Shaha AR.Implications of prognostic factors and risk groups inthe management of differentiated thyroid cancer[J].Laryngoscope, 2004, 114(3):393-402.
8.	任国胜, 苏新良.分化型甲状腺癌颈淋巴结清扫术式的选择[J].中国普外基础与临床杂志, 2010, 17(8):765-767.
9.	Sadowski BM, Snyder SK, Lairmore TC.Routine bilateral central lymph node clearance for papillary thyroid cancer[J].Surgery, 2009, 146(4):696-703.
10.	Pereira JA, Jimeno J, Miquel J.Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma[J].Surgery, 2005, 138(6):1095-1100.
11.	Takada H, Kikumori T, Imai T, et al.Patterns of lymph node metastases in papillary thyroid carcinoma:results from consecutive bilateral cervical lymph node dissection[J].World J Surg, 2011, 35(7):1560-1566.
12.	Roh JL, Kim JM, Park CI.Lateral cervical lymph node metastases from papillary thyroid carcinoma:pattern of nodal metastases and optimal strategy for neck dissection[J].Ann Surg Oncol, 2008, 15(4):1177-1182.
13.	Ferlito A, Rinaldo A, Robbins KT, et al.Changing concepts in the surgical management of the cervical node metastasis[J].Oral Oncol, 2003, 39(5):429-435.
14.	Machens A, Hinze R, Thomusch O, et al.Pattern of nodal metas-tasis for primary and reoperative thyroid cancer[J].World J Surg, 2002, 26(1):22-28.
15.	Ducci M, Appetecchia M, Marzetti M.Neck dissection for surg-ical treatment of lymphnode metastasis in papillary thyroid carcinoma[J].J Exp Clin Cancer Res, 1997, 16(3):333-335.
16.	Machens A, Holzhausen HJ, Dralle H.Skip metastases in thyroid cancer leaping the central lymph node compartment[J].Arch Surg, 2004, 139(1):43-45.
17.	Koo BS, Choi EC, Yoon YH, et al.Predictive factors for ipsila-teral or contralateral central lymph node metastasis in unilateral papillary thyroid carcinoma[J].Ann Surg, 2009, 249(5):840-844.
18.	Koo BS, Choi EC, Park YH, et al.Occult contralateral central lymph node metastases in papillary thyroid carcinoma with unila-teral lymph node metastasis in the lateral neck[J].J Am Coll Surg, 2010, 210(6):895-900.
19.	Agarwal S, Chand G, Jaiswal S, et al.Pattern and risk factors of central compartment lymph node metastasis in papillary thyroid cancer:a prospective study from an endocrine surgery centre[J].J Thyroid Res, 2012, 2012:436243.
20.	Ozaki O, Ito K, Kobayashi K, et al.Modified neck dissection for patients with nonadvanced, differentiated carcinoma of the thyroid[J].World J Surg, 1988, 12(6):825-829.
21.	Lee SH, Lee SS, Jin SM, et al.Predictive factors for central compartment lymph node metastasis in thyroid papillary microcarcinoma[J].Laryngoscope, 2008, 118(4):659-662.
22.	Chung YS, Kim JY, Bae JS, et al.Lateral lymph node metastasis in papillary thyroid carcinoma:results of therapeutic lymph node dissection[J].Thyroid, 2009, 19(3):241-246.
23.	Inn Chul Nam, Jun Ook Park, Young Hoon Joo, et al.Pattern and predictive factors of regional lymph node metastasis in papillary thyroid carcinoma:a prospective study[J].Head Neck, 2013, 35(1):40-45.
24.	Chow SM, Law SC, Chan JK, et al.Papillary microcarcinoma of the thyroid-prognostic significance of lymph node metastasis and multifocality[J].Cancer, 2003, 98(1):31-40.
25.	Sugg SL, Ezzat S, Rosen IB, et al.Distinct multiple RET/PTC gene rearrangements in multifocal papillary thyroid neoplasia[J].J Clin Endocrinol Metab, 1998, 83(11):4116-4122.

1. Choi Y, Park KJ, Ryu S, et al.Papillary thyroid carcinoma invo-lving cervical neck lymph nodes:correlations with lymphangiogenesis and ultrasound features[J].Endocr J, 2012, 59(10):941-948.
2. Pelizzo MR, Boschin IM, Toniato A, et al.Papillary thyroid carc-inoma:35-year outcome and prognostic factors in 1858 patients[J].Clin Nucl Med, 2007, 32(6):440-444.
3. Zaydfudim V, Feurer ID, Griffin MR, et al.The impact of lymph node involvement on survival in patients with papillary and follic-ular thyroid carcinoma[J].Surgery, 2008, 144(6):1070-1077.
4. Wada N, Duh QY, Sugino K, et al.Lymph node metastasis from 259 papillary thyroid microcarcinomas:frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection[J].Ann Surg, 2003, 237(3):399-407.
5. Moo TA, McGill J, Allendorf J, et al.Impact of prophylactic central neck lymph node dissection on early recurrence in papillary thyroid carcinoma[J].World J Surg, 2010, 34(6):1187-1191.
6. Shindo M, Wu JC, Park EE, et al.The importance of central compartment elective lymph node excision in the staging and treatment of papillary thyroid cancer[J].Arch Otolaryngol Head Neck Surg, 2006, 132(6):650-654.
7. Shaha AR.Implications of prognostic factors and risk groups inthe management of differentiated thyroid cancer[J].Laryngoscope, 2004, 114(3):393-402.
8. 任国胜, 苏新良.分化型甲状腺癌颈淋巴结清扫术式的选择[J].中国普外基础与临床杂志, 2010, 17(8):765-767.
9. Sadowski BM, Snyder SK, Lairmore TC.Routine bilateral central lymph node clearance for papillary thyroid cancer[J].Surgery, 2009, 146(4):696-703.
10. Pereira JA, Jimeno J, Miquel J.Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma[J].Surgery, 2005, 138(6):1095-1100.
11. Takada H, Kikumori T, Imai T, et al.Patterns of lymph node metastases in papillary thyroid carcinoma:results from consecutive bilateral cervical lymph node dissection[J].World J Surg, 2011, 35(7):1560-1566.
12. Roh JL, Kim JM, Park CI.Lateral cervical lymph node metastases from papillary thyroid carcinoma:pattern of nodal metastases and optimal strategy for neck dissection[J].Ann Surg Oncol, 2008, 15(4):1177-1182.
13. Ferlito A, Rinaldo A, Robbins KT, et al.Changing concepts in the surgical management of the cervical node metastasis[J].Oral Oncol, 2003, 39(5):429-435.
14. Machens A, Hinze R, Thomusch O, et al.Pattern of nodal metas-tasis for primary and reoperative thyroid cancer[J].World J Surg, 2002, 26(1):22-28.
15. Ducci M, Appetecchia M, Marzetti M.Neck dissection for surg-ical treatment of lymphnode metastasis in papillary thyroid carcinoma[J].J Exp Clin Cancer Res, 1997, 16(3):333-335.
16. Machens A, Holzhausen HJ, Dralle H.Skip metastases in thyroid cancer leaping the central lymph node compartment[J].Arch Surg, 2004, 139(1):43-45.
17. Koo BS, Choi EC, Yoon YH, et al.Predictive factors for ipsila-teral or contralateral central lymph node metastasis in unilateral papillary thyroid carcinoma[J].Ann Surg, 2009, 249(5):840-844.
18. Koo BS, Choi EC, Park YH, et al.Occult contralateral central lymph node metastases in papillary thyroid carcinoma with unila-teral lymph node metastasis in the lateral neck[J].J Am Coll Surg, 2010, 210(6):895-900.
19. Agarwal S, Chand G, Jaiswal S, et al.Pattern and risk factors of central compartment lymph node metastasis in papillary thyroid cancer:a prospective study from an endocrine surgery centre[J].J Thyroid Res, 2012, 2012:436243.
20. Ozaki O, Ito K, Kobayashi K, et al.Modified neck dissection for patients with nonadvanced, differentiated carcinoma of the thyroid[J].World J Surg, 1988, 12(6):825-829.
21. Lee SH, Lee SS, Jin SM, et al.Predictive factors for central compartment lymph node metastasis in thyroid papillary microcarcinoma[J].Laryngoscope, 2008, 118(4):659-662.
22. Chung YS, Kim JY, Bae JS, et al.Lateral lymph node metastasis in papillary thyroid carcinoma:results of therapeutic lymph node dissection[J].Thyroid, 2009, 19(3):241-246.
23. Inn Chul Nam, Jun Ook Park, Young Hoon Joo, et al.Pattern and predictive factors of regional lymph node metastasis in papillary thyroid carcinoma:a prospective study[J].Head Neck, 2013, 35(1):40-45.
24. Chow SM, Law SC, Chan JK, et al.Papillary microcarcinoma of the thyroid-prognostic significance of lymph node metastasis and multifocality[J].Cancer, 2003, 98(1):31-40.
25. Sugg SL, Ezzat S, Rosen IB, et al.Distinct multiple RET/PTC gene rearrangements in multifocal papillary thyroid neoplasia[J].J Clin Endocrinol Metab, 1998, 83(11):4116-4122.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Pattern and Predictive Factors of Neck Lymph Node Metastasis in Papillary Thyroid Carcinoma

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