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Seung, Bong, Hyoung, Sung, Hyo, and Kang: Subclinical Central Lymph Node Metastasis in Papillary Thyroid Microcarcinoma Evaluated as cT1aN0 by Preoperative Imaging Study
Original Article

J Korean Thyroid Assoc 2013;6(2):121-125.

Published online: 3 May 2013

DOI: https://doi.org/10.11106/jkta.2013.6.2.121

Subclinical Central Lymph Node Metastasis in Papillary Thyroid Microcarcinoma Evaluated as cT1aN0 by Preoperative Imaging Study

Tae Kim Seung, Kwon Cheon Bong, Shin Lee Hyoung, Won Kim Sung, Sang Park Hyo, Dae Lee Kang

1Department of Otolaryngology-Head and Neck Surgery, Kosin University Gospel Hospital, Busan, Korea

2Department of Pathology, Kosin University Gospel Hospital, Busan, Korea

Address reprint requests to Kang Dae Lee, MD, PhD, Department of Otolaryngology-Head and Neck Surgery, Kosin University Gospel Hospital, Amnam-dong 34, Seo-gu, Busan 602-702, Korea Tel: 82-51-990-6470, Fax: 82-51-245-8539, E-mail: kdlee@gmail.com

Received 22 April 2013       Accepted 24 September 2013

Copyright © 2013, the Korean Thyroid Association. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background and Objectives

Papillary thyroid microcarcinoma (PTMC) generally has a highly favorable prognosis, however reports show a 30-65% prevalence of subclinical central lymph node metastasis. Therefore, the role of elective central neck dissection in PTMC treatment remains controversial. Our study focused on preoperative features of clinically lymph node negative and intracapsular (cT1aN0) PTMC and the correlation of these features with subclinical central lymph node metastasis.

Materials and Methods

Of 584 PTC patients who underwent thyroidectomy at the Kosin University Gospel Hospital from January 2009 to July 2011, 219 patients with cT1aN0 PTMC were reviewed retrospectively. Pathologic results were reviewed and various clinicopathologic prognostic factors were investigated.

Results

Postoperative pathology report revealed capsular invasion of primary tumor in 77 patients (35.2%) and subclinical central lymph node metastasis in 62 patients (28.3%). Tumor of the isthmic location was an independent predictor of subclinical central lymph node metastasis by multivariate analysis while multifocality showed borderline significance. The presence of extrathyroidal extension (ETE), multifocality, and cervical lymph node metastasis were significantly related to PTMC of isthmus. Seven of the 14 subjects with PTMC of the isthmus (50%) had pretracheal lymph node metastasis showing significant correlation (p=0.001).

Conclusion

Despite the absence of ETE and lymph node metastasis in the preoperative imaging studies, higher risk of subclinical central lymph node metastasis should be considered in PTMC with multifocality and tumor of the isthmus.

Keywords: Papillary thyroid microcarcinoma, Neck dissection

References

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Table 1.
Univariate analysis of clinicopathologic factors related to subclinical lymph node metastasis
Characteristics Number of patients pN1a pN0 p value
Age        
<45 yrs 77 (35.2%) 23 (29.9%) 54 (70.1%) 0.236
≥45 yrs 142 (64.8%) 39 (27.5%) 103 (72.5%)  
Gender        
Male 34 (15.5%) 15 (44.1%) 19 (55.9%) 0.037
Female 185 (84.5%) 47 (25.4%) 138 (74.6%)  
Size (clinical)        
≤5 mm 64 (29.2%) 17 (26.6%) 47 (73.4%) 0.745
>5 mm 155 (70.8%) 45 (29.0%) 110 (71.0%)  
Size (pathologic)        
≤5 mm 89 (40.6%) 23 (25.8%) 66 (74.2%) 0.544
> 5 mm pT 130 (59.3%) 39 (30.0%) 91 (70.0%)  
pTT a 142 (64.8%) 39 (27.5%) 103 (72.5%) 0.754
pT3, pT4 77 (35.2%) 23 (29.9%) 54 (70.1%)  
Multifocality        
No 174 (79.5%) 43 (24.7%) 131 (75.3%) 0.026
Yes 45 (20.5%) 19 (42.2%) 26 (57.8%)  
Tumor location (solitary lesion)        
Upper 1/3 24 (13.8%) 6 (25%) 18 (75%) 0.001
Middle 1/3 108 (62.1%) 19 (17.6%) 89 (82.4%)  
Lower 1/3 28 (16.1%) 9 (32.1%) 19 (67.9%)  
Isthmus 14 (8.0%) 9 (64.3%) 5 (35.7%)  
Operation extent        
TT with CND 118 (53.9%) 37 (31.4%) 81 (68.6%) 0.296
Lob with CND 101 (46.1%) 25 (24.8%) 76 (75.2%)

TT: total thyroidectomy, CND: central neck dissection, Lob: lobectomy

Table 2.
Multivariate analysis of clinicopathologic factors related to subclinical lymph node metastasis
Factors B (SE) p value Odd ratio 95% CI Odd ratio
Lower Upper
Gender 0.547 (0.463) 0.237 1.729 0.698 4.281
Multifocality 1.097 (0.627) 0.080 2.996 0.876 10.243
Tumor location (solitary lesion) 1.603 (0.735) 0.029 4.967 1.175 20.996

SE: standard error of estimates, CI: confidence interval

Table 3.
Multivariate analysis of clinicopathologic factors relate to papillary thyroid microcarcinoma of isthmus
Factors B (SE) p value Odd ratio 95% CI Odd ratio
Lower Upper
pT 0.850 (0.452) 0.060 2.340 0.966 5.669
pN 1.496 (0.454) 0.001 4.464 1.832 10.877
Multifocality 1.193 (0.465) 0.010 3.296 1.324 8.202

SE: standard error of estimates, CI: confidence interval

Table 4.
Location of solitary lesion and location of central lymph node metastasis
Tumor location Ipsilateral paratracheal LN Pretracheal LN Contralateral paratracheal LN
Upper 1/3 5/24 (20.8%) 2/24 (8.3%) 1/6 (16.7%)
Middle 1/3 14/108 (13.0%) 6/108 (5.6%) 4/19 (21.1%)
Lower 1/3 7/28 (25.0%) 2/28 (7.1%) 2/9 (22.2%)
Isthmus 5/14 (35.7%) 7/14 (50.0%) 2/9 (22.2%)
Total (n=187) 31/174 (19.3%) 17/174 (9.8%) 9/43 (20.9%)
p value 0.115 0.001 0.994

LN: lymph node

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