Lateral Lymph Node Metastasis Prediction in Papillary Thyroid Cancer Patients with Suspicious Preoperative Imaging Findings

Han Shin Lee; Eun Jung Jung; Ju Yeon Kim; Seung Jin Kwag; Taejin Park; Sang Ho Jeong; Chi Young Jeong; Young Tae Ju; Young Joon Lee; Soon Chan Hong; Sang Kyung Choi

doi:10.16956/kjes.2016.16.1.6

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Lee, Jung, Kim, Kwag, Park, Jeong, Jeong, Ju, Lee, Hong, and Choi: Lateral Lymph Node Metastasis Prediction in Papillary Thyroid Cancer Patients with Suspicious Preoperative Imaging Findings

Original Article

Korean J Endocrine Surg 2016;16(1):6-12.

Published online: 10 December 2016

DOI: https://doi.org/10.16956/kjes.2016.16.1.6

Lateral Lymph Node Metastasis Prediction in Papillary Thyroid Cancer Patients with Suspicious Preoperative Imaging Findings

Han Shin Lee, Eun Jung Jung¹, Ju Yeon Kim, Seung Jin Kwag, Taejin Park¹, Sang Ho Jeong¹, Chi Young Jeong, Young Tae Ju, Young Joon Lee, Soon Chan Hong, Sang Kyung Choi

Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea

¹Department of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea

Correspondence: Eun Jung Jung Department of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, 11, Samjeongja-ro, Seongsan-gu, Changwon 51472, Korea Tel: ＋82-55-214-1000 Fax: ＋82-55-214-1031 e-mail: drjej@gnu.ac.kr

Received 18 December 2015 Revised 10 January 2016 Accepted 18 January 2016

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

Lateral lymph node metastasis of papillary thyroid cancer (PTC) is indicative of tumor aggressiveness and can determine treatment strategies. However, the role of prophylactic lateral lymph node dissection in the management of PTC is unclear. This study evaluated factors predictive of lateral lymph node metastasis in patients with suspicious lymph node enlargement in preoperative imaging.

Methods

This retrospective study included 728 patients with newly diagnosed PTC who underwent therapeutic surgery. Clinicopathologic results were reviewed, and factors predictive of lateral lymph node metastasis were analyzed.

Results

Of the 242 patients with lymph node metastasis, 50 had lateral lymph node metastasis. Lateral lymph node metastasis was associated with sex, tumor size, preoperative thyroid stimulating hormone (TSH) concentration and presence of central lymph node metastasis. Among patients with suspicious lateral lymph node metastasis by ultrasonography, high TSH level (odds ratio 3.833, P=0.031) and number of metastatic central lymph nodes (odds ratio 3.68, P=0.025) were significantly predictive of lateral lymph node metastasis.

Conclusion

High serum TSH level and central lymph node metastasis were predictive of lateral lymph node metastasis in PTC patients with suspicious preoperative imaging findings. These predictive factors might help reduce unnecessary therapeutic lateral lymph node dissection.

Keywords: Papillary thyroid cancer, Lateral lymph node metastasis, TSH concentration, Ultrasonography

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Fig. 1.

Numbers of metastatic lateral lymph nodes according to risk score. The table shows the components of the scoring system and the mean numbers of lateral lymph node metastasis is shown in the right panel.

Table 1.

The clinicopathologic features of patients with papillary thyroid cancer

	Total patients (N=728)
Age (mean±SD, year)	15∼80 (48.73±12.60)
Sex
Male:Female (%)	114:614 (15.7:84.3%)
Operation methods
Less total thyroidectomy	209 (28.7%)
Total thyroidectomy	519 (71.3%)
Tumor size (mean±SD, cm)	0.1∼5.0 (1.08±0.75)
Size≤1 cm	463 (63.6%)
LN metastasis status
N0	486 (66.8%)
N1	242 (33.2%)
Subgroup (Central LNM:Lateral LNM)
Positive:negative	192 (26.4%)
Positive:positive	38 (5.2%)
Negative:positive	12 (1.6%)
Capsular invasion	338 (46.4%)
Multiplicity	216 (29.7%)
Thyroiditis	87 (12.0%)
Preoperation TSH level (mean±SD, mIU/L)	0.01∼13.60 (1.97±1.43)
Preoperative Tg Ag level (mean±SD, ng/mL)	0.01∼98.59 (53.02±42.02)
BMI (kg/m²)	14.01∼40.47 (24.63±3.57)
Underweight (＜18.5)	14 (1.9%)
Normal (18.5∼25)	418 (57.4%)
Over weight (25∼30)	243 (33.4%)
Obese (≥30)	53 (7.3%)

N = number; SD = standard deviation; LN = lymph node; LNM = lymph node metastasis; TSH = thyroid stimulating hormone; Tg = Thyroglobulin; BMI = body mass index.

Table 2.

Clinicopathological characteristics according to lymph node metastasis status

	LN metastasis status			Lateral LN metastasis status
	Negative (N=486)	Positive (N=242)	P value	Negative (N=678)	Positive (N=50)	P value
Sex (%)			0.018			0.008
Male	65 (13.4)	49 (20.2)		99 (14.6)	15 (30.0)
Female	421 (86.6)	193 (79.8)		579 (85.4)	35 (70.0)
Age	49.51±12.26	47.14±13.14	0.017	48.94±12.56	45.89±12.89	0.098
Tumor size (mean±SD, cm)	0.97±0.67	1.31±0.85	＜0.001	1.06±0.73	1.30±0.95	0.031
Capsular invasion (%)	201 (41.4)	137 (56.6)	＜0.001	312 (46.0)	26 (52.0)	0.464
Multiplicity (%)	118 (24.3)	98 (40.5)	＜0.001	197 (29.1)	19 (38.0)	0.200
Thyroiditis (%)	53 (11.0)	34 (14.0)	0.228	83 (12.3)	4 (8.0)	0.499
Preoperation TSH level (mean±SD, mIU/L)	1.93±0.67	2.05±1.43	0.293	1.93±1.41	2.40±1.62	0.027
Preoperation Tg Ag level (mean±SD, ng/mL)	42.78±35.21	72.56±47.94	0.012	51.10±40.30	75.66±56.63	0.188
BMI (mean±SD, kg/m²)	24.62±3.59	24.65±3.54	0.895	24.62±3.55	24.75±3.93	0.809
Central LN metastasis				193 (28.5)	38 (76.0)	＜0.001
Metastatic central LN number (mean±SD)				0.73±1.58	2.66±2.65	＜0.001

LN = lymph node; N = number; SD = standard deviation; BMI = body mass index.

Table 3.

Predictive factors of lateral LNM of the patients with ultrasonography-detectable suspicious lateral LNM

	Lateral LN metastasis status			Logistic regression analysis
	Negative (N=22)	Positive (N=50)	P value	OR (95%CI)	P value
Sex (M:F)	5:17	15:35	0.582
	(22.7%:77.3%)	(30.0%:70.0%)
Multiplicity	7 (31.8%)	19 (38.0%)	0.791
Capsular invasion	12 (54.5%)	26 (52.0%)	1.000
PTMC (≤1 cm)	13 (59.1%)	25 (50.0%)	0.610
Thyroiditis	7 (31.8%)	4 (8.0%)	0.028	4.312 (1.08∼17.27)	0.039
Age (year)	49.86±13.07	45.88±12.89	0.233
Size (cm) BMI (kg/m²)	1.10±0.60 24.10±3.18	1.30±0.95 24.75±3.93	0.366 0.501
TSH (mIU/L)	1.47±0.95	2.40±1.62	0.003
TSH＞1.97 mIU/L	4 (14.8%)	18 (40.0%)	0.034	3.8333 (1.13∼12.96)	0.031
Metastatic central LN number	r 1.23±1.95	2.66±2.65	0.013
Central LN meta ≥2	5 (22.7%)	26 (52.0%)	0.037	3.683 (1.18∼11.53)	0.025

LN = lymph node; N = number; OR = odds ratio; PTMC = Papillary thyroid microcarcinoma; BMI = body mass index; TSH = thyroid stimulating hormone.

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