Korean Journal of Head & Neck Oncology (대한두경부종양학회지)

The Korean Society for Head and Neck Oncology (대한두경부종양학회)
권호 표지

The Analysis of Central Cervical Lymph Nodes in Papillary Thyroid Carcinoma with Preoperative No Lymph Node Metastasis

림프절 전이가 발견되지 않은(cN0) 유두상 갑상선 암의 중앙 경부 림프절 분석

  • Kim, Yun-Jung (Department of Surgery, Busan Paik Hospital, Inje University College of Medicine) ;
  • Ha, Tae-Kwun (Department of Surgery, Busan Paik Hospital, Inje University College of Medicine) ;
  • Ryu, Sung-Mock (Department of Surgery, Busan Paik Hospital, Inje University College of Medicine) ;
  • Kim, Sang-Hyo (Department of Surgery, Busan Paik Hospital, Inje University College of Medicine)
  • 김윤정 (인제대학교 의과대학 부산백병원 외과학교실) ;
  • 하태권 (인제대학교 의과대학 부산백병원 외과학교실) ;
  • 유성목 (인제대학교 의과대학 부산백병원 외과학교실) ;
  • 김상효 (인제대학교 의과대학 부산백병원 외과학교실)
  • Published : 2010.11.26
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose : Papillary thyroid carcinoma (PTC) is known for malignant tumor which has a favorable prognosis and long-term survival. Although the prognosis for patients with PTC is generally good, PTC tends to have highly metastatic property. The purpose of this study was to analyze the central compartment lymph node in papillary thyroid cancer with no lymph node metastasis clinically and to assess the significance of prophylactic node dissection. Methods : A retrospective review was carried out in 394 patients with PTC who underwent surgery for the period from January 2004 to December 2006. The positive rate of the lymph node metastasis was analyzed. The relations between the central compartment lymph nodes and the patients' age, gender, tumor size, exrathyroidal extension(ETE), multifocality, and bilaterality were comparatively analyzed in PTC patients with preoperative no lymph node metastasis. Results : The enrolled patients were 40 male and 354 female cases. The 118 cases of them were found to have cervical lymph node metastasis. The mean age was 46 years(range, 15-77years). Tumor size(p=0.000), ETE(p=0.001), multifocality(p=0.014), and bilaterality(p=0.001) were significantly related factors for cervical lymph node metastasis clinically in papillary thyroid cancer. However, age and gender were not significantly related with lymph node metastasis. Conclusion : Although no lymph node metastasis clinically, prophylactic neck node dissection can be performed to avoid risks of local recurrence and reoperation in the light of PTC nature. The pathological status and high positive rate of central compartment lymph node relate to tumor size and extrathyroidal extension. Close surveillance for nodal status is required in follow-up.

Keywords

References

  1. Machens A, Hinze R, Thomusch O, Dralle H. Pattern of nodal metastasis for primary and reoperative thyroid cancer. World J Surg. 2002;26:22-28. https://doi.org/10.1007/s00268-001-0176-3
  2. Wada N, Duh QY, Sugino K. Lymph node metastasis from 259 papillary thyroid microcarcinoma: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg. 2003;237:399-407.
  3. Mirallie E, Visset J, Sagan C, Hamy A, Le Bodic MF, Paineau J. Localization of cervical node metastasis of papillary thyroid carcinoma. World J Surg. 1999;23:970-973. https://doi.org/10.1007/s002689900609
  4. Caron NR, Clark OH. Well differentiated thyroid cancer. Scand J Surg. 2004;93:261-271. https://doi.org/10.1177/145749690409300403
  5. Ito Y, Tomoda C, Uruno T. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid. World J Surg. 2006;30:91-99. https://doi.org/10.1007/s00268-005-0113-y
  6. Kouvaraki MA, Shapiro SE, Fornage BD. Role of preoperative ultrasonography in the surgical management of patients with thyroid cancer. Surgery. 2003;134:946-954. https://doi.org/10.1016/S0039-6060(03)00424-0
  7. Mazzaferri EL. A vision for the surgical management of papillary thyroid carcinoma: extensive lymph node compartmental dissections and selective use of radioiodine. J Clin Endocrinol Metab. 2009;94:1086-1088. https://doi.org/10.1210/jc.2009-0298
  8. Pereira JA, Jimeno J, Miquel J, Iglesias M, Munne A, Sancho JJ, et al. Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma. Surgery. 2005;138: 1095-1100. https://doi.org/10.1016/j.surg.2005.09.013
  9. Watkinson JC, Franklyn JA, Olliff JF. Detection and surgical treatment of cervical lymph nodes in differentiated thyroid cancer. Thyroid. 2006;16:187-194. https://doi.org/10.1089/thy.2006.16.187
  10. Marshall CL, LEE JE, Xing Y, Perrier ND, Edeiken BS, Evans DB, et al. Routine pre-operative Ultrasonography for papillary thyroid cancer: effects on cervical recurrence. Surgery. 2009;146: 1063-1072. https://doi.org/10.1016/j.surg.2009.09.027
  11. Sugitani I, Fujimoto Y, Yamada K, Yamamoto N. Prospective outcomes of selective lymph node dissection for papillary thyroid carcinoma based on preoperative ultrasonography. World J Surg. 2008;32: 2494-2502. https://doi.org/10.1007/s00268-008-9711-9
  12. Loh K, Green span FS, Gee L. Pathological tumor node metastasis( pTNM) staging of papillary and follicular thyroid carcinomas: Retrospective analysis of 700 patients. J Clin Endo-crinol Metab. 1997;82:3553-3562. https://doi.org/10.1210/jc.82.11.3553
  13. Appetecchia M, Scarcello G, Pucci E, Procaccini A. Outcome after treatment of papillary thyroid microcarcinoma. J Exp Clin Cancer Res. 2002;21(2):159-164.
  14. Kasai N, Sakamoto A. New subgrouping of small thyroid carcinomas. Cancer. 1987;60(8):1767-1770. https://doi.org/10.1002/1097-0142(19871015)60:8<1767::AID-CNCR2820600816>3.0.CO;2-P
  15. Park HL, Kwak JK, Kang SS, Kim DY, Kang HG, Shin JY, et al. The analysis of tumor aggressiveness according to tumor size in occult papillary thyroid carcinoma. J Korean Surg Soc. 2007;73 (6):470-475.