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Objective:To investigate the correlation of central compartment lymph node metastasis(CLNM) in stage T 1a solitary papillary thyroid carcinoma (PTC) with the clinicopathological characteristics, sonographic features and the number of lymph node dissection, and to analyze the risk factors of CLNM. Methods:The data of 218 patients with stage T 1a solitary PTC who underwent thyroid cancer surgery from January 2017 to May 2021 in Tangshan Union Medical College Hospital were retrospectively analyzed. All patients were divided into CLNM positive group and CLNM negative group according to CLNM. The age, gender, preoperative sonographic features, pathological type, the number of lymph node dissection and the number of metastasis were recorded. Logistic regression was used to analyze the risk factors of CLNM. Results:Among 218 patients, there were 71 cases (32.6%) in CLNM positive group and 147 cases (67.4%) in CLNM negative group. There were statistically significant differences in age, tumor diameter, capsular invasion in thyroid or not, tumor blood supply or not, and the number of lymph node dissection between two groups (all P < 0.05). There were no statistically significant differences in gender, clear tumor boundary or not, tumor shape, tumor aspect ratio, calcification, nodular goiter and Hashimoto's thyroiditis or not (all P > 0.05). Multivariate binary logistic regression analysis showed that age < 55 years ( OR = 2.995, 95% CI 1.228-7.307), capsular invasion in thyroid ( OR = 5.297, 95% CI 2.494-11.248) and the number of lymph node dissection ≥6 ( OR = 4.085, 95% CI 2.059-8.104) were independent risk factors of CLNM (all P < 0.05). Conclusions:Patients with stage T 1a solitary PTC, age < 55 years and capsular invasion in thyroid are prone to CLNM; sufficient number of lymph node dissection can get more accurate CLNM rate.
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Objective To establish an artificial intelligence model based on B-mode thyroid ultrasound images to predict central compartment lymph node metastasis(CLNM)in patients with papillary thyroid carcinoma(PTC). Methods We retrieved the clinical manifestations and ultrasound images of the tumors in 309 patients with surgical histologically confirmed PTC and treated in the First Medical Center of PLA General Hospital from January to December in 2018.The datasets were split into the training set and the test set.We established a deep learning-based computer-aided model for the diagnosis of CLNM in patients with PTC and then evaluated the diagnosis performance of this model with the test set. Result The accuracy,sensitivity,specificity,and area under receiver operating characteristic curve of our model for predicting CLNM were 80%,76%,83%,and 0.794,respectively. Conclusion Deep learning-based radiomics can be applied in predicting CLNM in patients with PTC and provide a basis for therapeutic regimen selection in clinical practice.
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Humans , Artificial Intelligence , Lymph Nodes/diagnostic imaging , Lymphatic Metastasis , Retrospective Studies , Risk Factors , Thyroid Cancer, Papillary/diagnostic imaging , Thyroid Neoplasms/diagnostic imagingABSTRACT
Objective To investigate the predictive factors for central lymph node metastasis (CLNM) in papillary thyroid microcarcinoma(PTMC).Methods A retrospective study including 2511 cases of PTMC admitted from Jan.2013 to Jan.2016 were enrolled in our study.Chi-square test was used in univariate analysis.Logistic regression analysis was applied for multivariate analysis.The relation between age,sex,tumor size,multifocality,thyroidal extension,nodular goiter and central lymph node metastasis is analyzed.Results Univariate analysis showed that age,sex,tumor size,multifocality,thyroidal extension and nodular goiter had statistical significance.Age less than 45(P＜0.001,x2=17.442);Male gender(P＜0.001,x2=17.029);Tumor size less than 5 mm (P＜0.001,x2=70.164.);Extrathyroid extension factor (P＜0.001,x2=63.197);Nodular hyperplasia factor (P=0.017,x2=5.611).Multivariate analysis showed there was a significant relationship between multifocality and the central lymph node positivity.The odds ratio (OR) was 1.587 in patients with tumor foci ≥2(P＜0.001).While OR increased sharply near to 3 in patients withtumor foci ≥3(OR=2.730).Tumor size(OR=1.926);Extrathyroid extension(OR=1.606).Conclusions Multifocalty,tumor size and thyroidal extension are the main predicative factors for central lymph node metastasis in PTMC.Among them,tumor foci ≥ 3 is an important predictor.Besides the conventional factors such as tumor size,thyroidal extension etc,multifocalty should also be taken into consideration.
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OBJECTIVE The objective of this study is to discuss when to dissect the lymph nodes behind the right recurrent laryngeal nerve (LN-prRLN) from the standpoint of the right cervical level Ⅵ-1 (superficial layer to the recurrent laryngeal nerve) lymph nodes in papillary thyroid carcinoma (PTC) patients.METHODS The clinical data of 306 bilateral or right PTC patients from the Hangzhou First People's Hospital who underwent dissection of level Ⅵ-1 lymph nodes and LN-prRLN between March 2014 and September 2015 were analyzed. We measured the number of level Ⅵ-1 metastatic lymph nodes and size of level Ⅵ-1 lymph nodes metastasis loci to predict the metastasis of LN-prRLN.RESULTS The number of level Ⅵ-1 metastatic lymph nodes and size of level Ⅵ-1 lymph nodes metastasis loci were risk factors of LN-prRLN metastasis(P<0.05). When the number of the level Ⅵ-1 metastatic lymph nodes was greater than 1.5, the AUC was 0.813 (the sensitivity was 78.43%, the specificity was 76.65%). The ROC showed that when the size of level Ⅵ-1 lymph nodes metastasis loci were more than 0.45 cm, the AUC was 0.726 (sensitivity was 90.20%, specificity was 48.90%).CONCLUSION In bilateral or right PTC patients with metastasis of level Ⅵ-1 lymph nodes, especially when the number of level Ⅵ-1 metastatic lymph nodes was greater than 2cm and the metastasis loci were more than 0.45 cm, we should dissect the LN-prRLN.
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The incidence of papillary thyroid carcinoma (PTC) has been increasing in the past decades.The overall survival (OS) of most PTC patients is satisfied,however,recurrence is not rare.Surgical management is the basic treatment for PTC.The first step of surgery includes gland resection and lymph node dissection of central compartment.Several controversies remain in the indications and range of surgery.In this article,the progress of gland management,lymph node dissection in central compartment and complications in PTC/papillary thyroid microcarcinoma were reviewed.
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Objective:To determine the clinical features of papillary thyroid microcarcinoma (PTMC) and the risk factors for central compartment lymph node (CCLN) metastasis in PTMC. Methods:Data of 1 401 patients with PTMC who were treated in Tianjin Medi-cal University Cancer Institute and Hospital between January 2014 and December 2014 were retrospectively analyzed. Chi-square test and multivariate Logistic regression analysis were used to study the risk factors. Results:With regard to clinicopathological features, the sex ratio is 1:3.4 in patients with PTMC. CCLN metastasis affected 427 (30.5%) of the total 1 401 patients. Age (χ2=14.587, P6 mm, extracapsular spread, and tumor bilaterality were independently correlated with CCLN metastasis. Conclusion:A prophylactic neck dissection of the central compartment must be considered particularly in male PT-MC patients with age6 mm, extracapsular spread, and tumor bilaterality.
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Objective To assess clinical significance of the right side lymph node dissection behind recurrent laryngeal nerve (RLN) in papillary thyroid carcinoma (PTC).Methods Clinical data of 111 cases of PTC adimitted in our hospital (Department of Vascular and Thyroid Surgery,the Union Hospital of Fujian Medical University) from Feb.2013 to Mar.2014 were retrospectively analyzed.Central lymph node metastasis was analyzed.Univariate and multivariate analysis were made to analyze relations between the right side lymph node (Ⅵ b2) metastasis behind RLN and gender,age,tumor size,capsule infiltration and so on.Results Among 111 cases of PTC,71 had central lymph node metastasis (63.96％).Total metastasis number of the right side lymph node behind recurrent laryngeal nerve (Ⅵ b2) was 2.720±2.037,and the transfer rate was 27.03％ (30/111) (P＜0.05),all lower than those of Ⅵ bl.The one-way ANOVA results showed that metastasis of the right side lymph node behind RLN (Ⅵ b2) was related with age,lateral neck dissection,and Ⅵ b1 lymph node metastasis (P＜0.05) while Ⅵ bl lymph node metastasis was the only independent risk factor for metastasis of the right side lymph node behind RLN(Ⅵ b2) in PTC.Conclusion For patients with right PTC,the metastasis rate of Ⅵ b2 is high,thus dissection of this area is favorable and can accurately reflect lymph node metastasis and further to guide tumor staging and postoperative treatment.
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Objective:To investigate the risk factors of central lymph node metastasis (CLNM) and lateral neck lymph node me-tastasis in papillary thyroid microcarcinoma (PTMC) patients, and to analyze the importance of high resolution ultrasonography in the diagnosis of lateral neck lymph node metastasis in PTMC patients. Methods:A retrospective protocol was applied, and a total of 1 037 PTMC patients were reviewed. These patients underwent central lymph node dissection or thyroidectomy with lateral neck lymph node dissection between January and November in 2013 in the Tianjin Medical University Cancer Institute and Hospital. Clinicopathological factors, namely, age, sex, primary tumor size, multifocality, bilateralism, thyroid capsular invasion, and local invasion, were analyzed. Results: CLNMs were found in 332 of 1037 patients (32.0%), and 71 out of 1037 patients had lateral neck lymph node metastasis (6.85%). In the univariate analysis, patients with the following risk factors were at high risk of CLNM (P5 mm, multifocality, bilateralism, thyroid capsular invasion, and local invasion. Male patients with cen-tral lymph node metastasis positively showed high lateral neck lymph node metastasis rate (P5 mm, multifocality, bilateralism, thyroid capsular invasion, and lo-cal invasion). The importance of high-resolution ultrasonography in diagnosing lateral neck lymph node metastasis was revealed by the results. Thus, this method should be widely popularized. Radical neck dissection should be performed in male patients who received a positive diagnosis via ultrasonography or those with PTMC who had more than three positive nodes in the central lymph node metasta-sis. However, given the high occurrence rate of PTMC, a prospective study needs to be conducted in the future.
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Papillary thyroid cancer is a common endocrine cancer and commonly presents with lymph node metastases. It has been generally accepted that lymphatic drainage occurs from the thyroid primarily to the central lymphatic compartment and secondarily to the lateral compartment nodes. Recently, improvements in the resolution of imaging studies and the availability of highly sensitive thyroglobulin assays have highlighted the importance of identifying disease in the pre-operative assessment and dealing effectively with metastatic regional disease in order to prevent recurrence. However, there are limitations to diagnosing central lymph node metastases. With unreliable imaging modalities, prophylactic central lymph node dissection should be performed on all patients with papillary thyroid cancer. In comparison with the central compartment, prophylactic lateral node dissection has little or no effect on improving the prognosis of patients with papillary thyroid cancer. Therefore, lateral node dissection is recommended only as a part of the therapeutic procedure. The extension of lateral neck dissection is recommended a comprehensive selective neck dissection of levels IIa, III, IV, and Vb. The rich lymphatic supply of the thyroid gland coupled with the propensity for nodal metastases in papillary thyroid cancer require the modern thyroid surgeon to be familiar with the indications for and techniques of regional lymph node dissection.
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Humans , Drainage , Endocrine Gland Neoplasms , Lymph Node Excision , Lymph Nodes , Neck Dissection , Neoplasm Metastasis , Prognosis , Recurrence , Thyroglobulin , Thyroid Gland , Thyroid NeoplasmsABSTRACT
OBJECTIVE: To provide a method for calculating mean residence time of drugs in central compartment (MRTC).
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Background and purpose: The aim of this study was to determine the necessity of central compartment neck dissection in laryngeal cancer.Study Design: Retrospective study at a tertiary referral medical center. Methods:Patients with laryngeal squamous cell cancer who underwent neck dissection were evaluated, and a retrospective analysis of clinicopathologic factors and follow-up data were performed. Results: One hundred and eighteen patients from 1999 to 2009 were enrolled. There were 11.9% central compartment lymph node metastasis in all patients, including the 10 patients with central compartment lymph node metastasis in 34 patients underwent compartment neck dissection and 4 patients do not underwent compartment neck dissection but had central neck recurrence in the follow up time. Subglottic or pyriform extension were risk factors in central compartment lymph node metastasis and central neck recurrence (P=0.002). Central compartment lymph node metastasis had closed relationship with levelⅣmetastasis (P<0.001), extracapsular extension (P=0.001), vascular extension (P=0.015) and poor local control rates (P=0.035) respectively. Patients who were positive for lateral neck lymph node metastasis had poor disease-free survival rate (P=0.014) and poor local control rates (P=0.025), and supraglottic cancer had a trend to metastases to levelⅡ(P=0.044). Conclusion:Central compartment neck dissection might be considered a potential therapeutic approach for patients with laryngeal cancer.
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Objetivo: Evaluar la hipocalcemia y lesión del nervio laríngeo recurrente secundaria a tiroidectomía total acompañada de disección del compartimiento central en cáncer papilar de tiroides. Sede: Instituto Nacional de Cancerología, México. Diseño: Estudio clínico descriptivo, observacional, prospectivo, longitudinal. Análisis estadístico: Porcentajes como medida de resumen para variables cualitativas. Pacientes y métodos: Veinte y cuatro pacientes con diagnóstico de cáncer papilar de tiroides (CPT) establecido mediante citología y/o histopatología, que se llevaron a disección central del cuello como parte del tratamiento quirúrgico inicial con seguimiento mínimo de 6 meses. Variables estudiadas: Tiempo quirúrgico, sangrado transoperatorio, movilidad cordal evaluadas por laringoscopia directa pre y postoperatoriamente, hipocalcemia e hipoparatiroidismo, reintervención y número de ganglios resecados. Resultados: De los 24 pacientes, 16 con enfermedad confinada al tiroides y 8 con afección al cuello, el tiempo quirúrgico medio de 2 a 4.30 horas con una media de 2.2, sangrado de 100 a 400 ml con media de 196 ml. Un paciente con hipocalcemia transitoria, cero pacientes con hipocalcemia permanente corroborado con paratohormona, cero lesiones del nervio laríngeo recurrente (NLRL), cero reintervenciones, el número de ganglios resecados fue de 7 a 16. Conclusiones: La morbilidad de la tiroidectomía total más disección del compartimiento central fue de hipocalcemia transitoria de 4.1%. No existió lesión de nervio laríngeo recurrente ni hipoparatiroidismo.
Objective: To assess hypocalcemia and injury to the recurrent laryngeal nerve secondary to total thyroidectomy plus central compartment dissection in papillary thyroid cancer. Setting: National Institute of Cancerology, Mexico Design: Descriptive, observational, retrospective, prospective, longitudinal clinical study. Statistical analysis: Percentages as summary measure for qualitative variables. Patients and methods: Twenty-four patients with diagnosis of papillary thyroid cancer (PTC), established by cytology and histopathology, subjected to central dissection of the neck as part of the initial surgical treatment with a follow-up of at least 6 months. Assessed variables were: surgical time, trans-operative bleeding, vocal cords mobility, assessed through direct laryngoscopy pre- and postoperatively, hypocalcemia and hypothyroidism, re-intervention, and number of dissected ganglia. Results: Twenty four patients, 16 with thyroid-confined disease, and 8 with neck involvement. Average surgical time of 2 to 4.30 hours, mean of 2.2, bleeding of 100 to 400 ml, mean of 196 ml. One patient with transient hypocalcemia, nill patients with permanent hypocalcemia confirmed with PHT testing, nill Recurrent laryngeal nerve (NLRL) injuries, nill re-interventions; the number of dissected ganglia was 7 to 16. Conclusions: Morbidity of total thyroidectomy plus dissection of the central compartment consisted of transient hypocalcemia (4.1%). Neither recurrent laryngeal nerve injury nor hypoparathyroidism occurred.
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PURPOSE: Prophylactic central compartment node dissection is gaining acceptance in the treatment of papillary thyroid carcinoma (PTC). However, its benefits remain controversial. The aim of study was to evaluate the effects of prophylactic central compartment node dissection on the complication rate and the short-term disease-free survival rate. METHODS: Our treatment strategy for PTC without clinical evidence of lymph node metastasis has been changed from total thyroidectomy alone (group I) to total thyroidectomy with prophylactic central compartment node dissection (group II) since January 2007. Before and after 2007, 70 consecutive patients were selected in each group. RESULTS: The average age of patients was 46.3±11.8 years. Average follow-up period was 51.9±10.9 months. The average size of maximum diameters of the tumors was 1.3±0.8 cm. Lymph node metastasis was identified in 22.9% of patients in group II. Recurrent laryngeal nerve injury occurred in one patient in each group. Temporary and permanent hypoparathyroidism occurred in 32.9% and 2.9% in group I, 40.0% and 7.1% in group II respectively (P=0.483 and P=0.441, respectively). Locoregional recurrences developed in seven patients in group I. Fifty month disease-free survival rate was 90.0% and 100% in group I and group II, respectively (P=0.0078). CONCLUSION: Prophylactic central compartment node dissection did not seem to increase the risk of recurrent laryngeal nerve injury, but may increase the risk of temporary and permanent hypoparathyroidism. Prophylactic central compartment node dissection decreased the risk of locoregional recurrences, especially in central compartment. However, the size of metastatic lymph nodes in central compartment in the present study was relatively small and their clinical implication remains to be evaluated.
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Humans , Disease-Free Survival , Follow-Up Studies , Hypoparathyroidism , Lymph Nodes , Neoplasm Metastasis , Recurrence , Recurrent Laryngeal Nerve Injuries , Thyroid Gland , Thyroid Neoplasms , ThyroidectomyABSTRACT
OBJECTIVES: It remains unclear as to whether routine central neck dissection (CND) is necessary when performing surgery to treat patients with papillary thyroid microcarcinoma (PTMC). To determine the necessity for routine CND in PTMC patients, we reviewed the clinicopathologic and laboratory data of the patients of PTMC. METHODS: Between September 2001 and July 2005, 101 patients with PTMC and clinical N0 disease were retrospectively reviewed. The study cohort was devided into groups: the total thyroidectomy plus CND group (the CND group, N=48) and the total thyroidectomy without CND group (the no CND group, N=53). The serum stimulated thyroglobulin (Tg) levels were measured after surgery and prior to radioactive iodine ablation therapy (RAI) and at 6-12 months after RAI. Pathology, the Tg levels and recurrence data were compared between the 2 groups. RESULTS: Central nodal metastases were found in 18 of the 48 CND patients (37.5%). The incidence of Tg levels >5 ng/mL at RAI was higher in the no CND patients and in the 18 node-positive CND patients compared with the 30 node-negative CND patients (22-24% vs. 3%, respectively, P=0.020-0.058). The difference when performing a similar comparison using a >2 ng/mL Tg threshold level showed no significance (10-11% vs. 4%, respectively, P>0.1). Two of the no CND patients and one node-positive CND patient had recurrences in the thyroid bed or lateral neck during a mean follow-up of 24 months. CONCLUSION: The data showed that occult metastasis to the central neck is common in PTMC patients. A CND provides pathologic information about the nodal metastases, and it potentially provides guidance for planning the postoperative RAI. However, the long-term benefit of CND on recurrence and survival remains somewhat questionable.
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Humans , Carcinoma, Papillary , Cohort Studies , Follow-Up Studies , Incidence , Iodine , Neck , Neck Dissection , Neoplasm Metastasis , Recurrence , Retrospective Studies , Thyroglobulin , Thyroid Gland , Thyroid Neoplasms , ThyroidectomyABSTRACT
Thyroid microcarcinoma(TMC) is defined by the World Health Organization as carcinoma 1.0cm or less in its greatest dimension. TMC is being found in an increasing proportion of treated thyroid carcinomas due to the more frequent use and the technical improvement of ultrasonography and fine needle aspiration biopsy. Clinicians should be aware of the differences between TMC and clinical thyroid cancer (more than 1cm in diameter) when making a surgical decision. The aims of this study are to characterize the clinical and biological behaviors of TMC, to demonstrate the prognosis according to the risk factors and treatment modality, and to suggest a proper surgical management of TMC.