A Prospective Study to Find the Significance of Delphian Nodal Metastasis in Papillary Carcinoma Thyroid

Abstract

Delphian node (DLN) involvement is well known for its poor prognosis in laryngeal malignancies. With less than 10 studies available with respect to DLN and carcinoma thyroid, this prospective study to analyze the significance of DLN in management of thyroid carcinoma was planned. Study included 151 patients with histopathologically proven papillary carcinoma thyroid. Histopathological factors analyzed included size of the tumor, isthmus involvement, tumor capsule involvement, extrathyroidal extension, multifocality, lymphovascular invasion, thyroiditis, and pyramidal lobe association. DLN was harvested in 80 patients (53%). Seventeen patients (21.25%) had DLN metastasis. Male gender, capsular involvement, and extrathyroidal extension were independently associated with metastatic in DLN. DLN metastasis had accuracy of 83.8% to predict central compartment neck nodal involvement, risk of which is increased by 24.7 times compared to DLN with no nodal metastasis. Similarly, DLN metastasis is associated with an accuracy of 81.3% to predict lateral compartment neck nodal involvement risk of which is increased by 9.8 times compared to DLN with no nodal metastasis, both of which showed a significant p value of 0.0001. DLN involvement is a predictor of nodal metastasis which mandates an aggressive treatment and a close follow-up. When DLN is involved with total thyroidectomy with central compartment neck dissection has to be performed and lateral neck dissection is preferred on the side of disease when DLN is involved with capsular invasion, extrathyroidal extension and in case of male gender, after radiological correlation.