Journal List > Korean J Endocr Surg > v.16(1) > 1060168

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

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.

References

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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.
kjes-16-6f1.tif
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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