Prediction of Nodal Metastasis by the AMES Scoring System in Patients with Papillary Thyroid Cancer

Youn-Ju Lee; Je-Ryong Kim

doi:10.16956/kjes.2015.15.4.86

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Lee and Kim: Prediction of Nodal Metastasis by the AMES Scoring System in Patients with Papillary Thyroid Cancer

Original Article

Korean J Endocrine Surg 2015;15(4):86-92.

Published online: 10 December 2015

DOI: https://doi.org/10.16956/kjes.2015.15.4.86

Prediction of Nodal Metastasis by the AMES Scoring System in Patients with Papillary Thyroid Cancer

Youn-Ju Lee, Je-Ryong Kim

Department of Surgery, Chungnam National University School of Medicine, Daejeon, Korea

Correspondence: Je-Ryong Kim Department of Surgery, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea Tel: ＋82-42-280-7184 Fax: ＋82-42-257-8024 e-mail: kimjr@cnuh.co.kr

Received 12 October 2015 Revised 30 October 2015 Accepted 9 November 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We assessed the prognostic value of AMES to determine the extent of surgery in PTC patients, and compared AMES score usefulness and accuracy with [¹⁸F] FDG PET/CT.

Methods

We conducted a review of data from a single center and a single surgeon, who treated 341 patients with PTC with total thyroidectomy and prophylactic bilateral CLN dissection at a tertiary referral center, Chungnam National University Hospital, between 2001 and 2012.

Results

In multivariate analysis, the rate of CLN metastasis was considerably higher in PTC patients with the higher AMES score (odds ratio [OR], 1.718; 95% confidence interval [CI], 1.073∼2.752), higher SUV of the CLN (＞0) (OR, 6.525; CI, 3.184∼13.371), higher SUV of the tumor (＞4.3) (OR, 1.855; CI, 1.065∼3.231).

Conclusion

The AMES score is helpful in deciding whether to perform a CLN dissection, as there is a strong association between the AMES score and CLN metastasis. This high predictive value of CLN metastasis can help determine the extent of PTC surgery while considering the cost and effort.

Keywords: Papillary thyroid carcinoma, Central lymph node, AMES, Lymph node metastasis, Positron emission tomography-computed tomography

References

1. Moo TA, McGill J, Allendorf J, Lee J, Fahey T 3rd, Zarnegar R. Impact of prophylactic central neck lymph node dissection on early recurrence in papillary thyroid carcinoma. World J Surg. 2010; 34:1187–91.

2. Shaha AR. Implications of prognostic factors and risk groups in the management of differentiated thyroid cancer. Laryngoscope. 2004; 114:393–402.

3. Lee YS, Kim SW, Kim SW, Kim SK, Kang HS, Lee ES, et al. Extent of routine central lymph node dissection with small papillary thyroid carcinoma. World J Surg. 2007; 31:1954–9.

4. Sugitani I, Fujimoto Y. Symptomatic versus asymptomatic papillary thyroid microcarcinoma: a retrospective analysis of surgical outcome and prognostic factors. Endocr J. 1999; 46:209–16.

5. Hay ID, Grant CS, Bergstralh EJ, Thompson GB, van Heerden JA, Goellner JR. Unilateral total lobectomy: is it sufficient surgical treatment for patients with AMES low-risk papillary thyroid carcinoma? Surgery. 1998; 124:958–64.

6. Dionigi G, Dionigi R, Bartalena L, Boni L, Rovera F, Villa F. Surgery of lymph nodes in papillary thyroid cancer. Expert Rev Anticancer Ther. 2006; 6:1217–29.

7. Pellegriti G, Scollo C, Lumera G, Regalbuto C, Vigneri R, Belfiore A. Clinical behavior and outcome of papillary thyroid cancers smaller than 1.5 cm in diameter: study of 299 cases. J Clin Endocrinol Metab. 2004; 89:3713–20.

8. Bilimoria KY, Bentrem DJ, Ko CY, Stewart AK, Winchester DP, Talamonti MS, et al. Extent of surgery affects survival for papillary thyroid cancer. Ann Surg. 2007; 246:375–81.

9. Kim H, Na KJ, Choi JH, Ahn BC, Ahn D, Sohn JH. Feasibility of FDG-PET/CT for the initial diagnosis of papillary thyroid cancer. Eur Arch Otorhinolaryngol 2015. [Epub ahead of print].

10. Wang W, Larson SM, Fazzari M, Tickoo SK, Kolbert K, Sgouros G, et al. Prognostic value of [¹⁸F] fluorodeoxyglucose positron emission tomographic scanning in patients with thyroid cancer. J Clin Endocrinol Metab. 2000; 85:1107–13.

11. Rossi RL, Cady B, Silverman ML, Wool MS, Horner TA. Current results of conservative surgery for differentiated thyroid carcinoma. World J Surg. 1986; 10:612–22.

12. Cady B, Rossi R. An expanded view of risk-group definition in differentiated thyroid carcinoma. Surgery. 1988; 104:947–53.

13. Cady B. Hayes Martin Lecture. Our AMES is true: how an old concept still hits the mark: or, risk group assignment points the arrow to rational therapy selection in differentiated thyroid cancer. Am J Surg. 1997; 174:462–8.

14. Shah JP, Loree TR, Dharker D, Strong EW, Begg C, Vlamis V. Prognostic factors in differentiated carcinoma of the thyroid gland. Am J Surg. 1992; 164:658–61.

15. Hay ID, Bergstralh EJ, Goellner JR, Ebersold JR, Grant CS. Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery. 1993; 114:1050–7.

16. Haigh PI, Urbach DR, Rotstein LE. Extent of thyroidectomy is not a major determinant of survival in low- or high-risk papillary thyroid cancer. Ann Surg Oncol. 2005; 12:81–9.

17. Roh JL, Kim JM, Park CI. Central lymph node metastasis of unilateral papillary thyroid carcinoma: patterns and factors predictive of nodal metastasis, morbidity, and recurrence. Ann Surg Oncol. 2011; 18:2245–50.

18. Wada N, Duh QY, Sugino K, Iwasaki H, Kameyama K, Mimura T, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg. 2003; 237:399–407.

19. Moo TA, Umunna B, Kato M, Butriago D, Kundel A, Lee JA, et al. Ipsilateral versus bilateral central neck lymph node dissection in papillary thyroid carcinoma. Ann Surg. 2009; 250:403–8.

20. Palestini N, Borasi A, Cestino L, Freddi M, Odasso C, Robecchi A. Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer? Our experience. Langenbecks Arch Surg. 2008; 393:693–8.

21. Grebe SK, Hay ID. Thyroid cancer nodal metastases: biologic significance and therapeutic considerations. Surg Oncol Clin N Am. 1996; 5:43–63.

22. Schindler AM, van Melle G, Evequoz B, Scazziga B. Prognostic factors in papillary carcinoma of the thyroid. Cancer. 1991; 68:324–30.

23. Tubiana M, Schlumberger M, Rougier P, Laplanche A, Benhamou E, Gardet P, et al. Long-term results and prognostic factors in patients with differentiated thyroid carcinoma. Cancer. 1985; 55:794–804.

24. Scheumann GF, Gimm O, Wegener G, Hundeshagen H, Dralle H. Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer. World J Surg. 1994; 18:559–67.

25. Podnos YD, Smith D, Wagman LD, Ellenhorn JD. The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer. Am Surg. 2005; 71:731–4.

Fig. 1.

Receiver operating characteristic curve of tumor SUVmax. With an SUVmax cutoff value of above 4.3, the surgeon can predict central lymph node (CLN) metastasis, and proceed total thyroidectomy and CLN dissection.

Fig. 2.

Receiver operating characteristic curve of SUVmax. With an SUVmax cutoff value of above 0, the surgeon can predict central lymph node (CLN) metastasis, and proceed total thyroidectomy and CLN dissection.

Table 1.

Clinicopathological data in relation to CLN in PTC

	No. of patients (n=341)	Positive CLN (%)	Negative CLN (%)	P value
Age (years)				.000
＜45	101	64 (63.4)	37 (36.6)
≥45	240	85 (35.4)	155 (64.6)
Sex				.488
Male	38	19 (50)	19 (50)
Female	303	130 (42.9)	173 (57.1)
Tumor size (cm)				.000
ϕ≤0.5 cm	117	29 (24.8)	88 (75.2)
0.5＜ϕ≤1 cm	131	50 (38.1)	81 (61.9)
1＜ϕ≤2 cm	70	51 (72.9)	19 (27.1)
ϕ＞2 cm	23	19 (82.6)	4 (17.4)
Bilaterality				.714
Unilateral	247	106 (42.9)	141 (57.1)
Bilateral	94	43 (45.7)	51 (54.3)
Multiplicity				.174
Solitary	216	88 (40.7)	128 (59.3)
Multiple	125	61 (48.8)	64 (51.2)
Capsule invasion				.000
Yes	197	105 (53.3)	92 (46.7)
No	144	44 (30.5)	100 (69.5)
Extrathyroidal extension				.000
Yes	154	83 (53.9)	71 (46.1)
No	187	66 (35.3)	121 (64.7)
Lymphovascular invasion				.000
Yes	258	139 (53.8)	119 (46.2)
No	83	10 (12.0)	73 (88.0)

CLN = central lymph node; PTC = papillary thyroid cancer; ϕ = maximal tumor diameter.

Table 2.

Associations of CLN metastasis with AMES, MACIS, SUV

Variables	Negative CLN (%)	Positive CLN (%)	Total	Univariate P value	Exp (β)	95% CI Lower	Exp (β) Upper
AMES score				.001	1.718	1.073	2.752
Low	121 (64.7)	66 (35.3)	187
High	71 (46.1)	83 (53.9)	154
MACIS score				.378
＜7	187 (56.8)	142 (43.2)	329
≥7	5 (41.7)	7 (58.3)	12
SUV of CLN				.000	6.525	3.184	13.371
0	181 (64.9)	98 (35.1)	279
≥0	11 (17.7)	51 (82.3)	62
SUV of tumor				.000	1.855	1.065	3.231
≤4.3	68 (73.9)	24 (26.1)	92
＞4.3	124 (49.8)	125 (50.2)	249

SUV = Standardized uptake values; CLN = central lymph node; AMES = Age, distant Metastasis, Extrathyroidal invasion, and Size;

MACIS = Metastasis, Age, Completeness of resection, Invasion, and Size; CI = confidence interval.

Table 3.

Associations of CLN metastasis with predictive values by multivariate logistic regression analysis

Variables	Exp (β)	95.0% CI	I Exp (β)
Variables	Exp (β)	Lower	Upper
Age＜45	2.743	1.535	4.901
Tumor size
0.5＜ϕ≤1 cm	1.124	0.591	2.139
1＜ϕ≤2 cm	2.882	1.271	6.532
ϕ＞2 cm	4.495	1.151	17.549
Capsular invasion	1.385	0.614	3.124
Extrathyroidal extension	0.747	0.347	1.608
Lymphovascular invasion	6.680	2.941	15.998
SUV of CLN＞0	4.519	2.000	10.212
SUV of tumor＞4.3	1.217	0.637	2.327

SUV = Standardized uptake values; CLN = central lymph node; ϕ = maximal tumor diameter; Exp (β) = odds ratio; CI = confidence interval.

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