Abstract
Objective To explore the risk factors of level V lymphatic metastasis in papillary thyroid carcinoma (PTC) patients with pN1b. Methods Patients were selected if they presented with a suspicious level III or IV lymph node metastasis and underwent surgery by hemi or total thyroidectomy with a lymph node dissection (levels III, IV, VI, and VII). For these patients, if frozen section showed a positive level III or IV node, then levels II and V nodes were resected. Univariate analysis was performed using the chi-square test for some factors, including age, sex, tumor location, multifocal lesions, tumor size, local invasion of primary focus, status of cervical lymphatic metastasis, TNM staging, tumor deposits (independent tumor nodules), and the metastasis to more than 5 central lymph nodes. Then, the factors with statistical significance indicated by the above univariate analysis underwent multivariate analysis. Results Univariate analysis indicated that the level V lymphatic metastasis was significantly associated with simultaneous metastases to levels II, III, and IV, simultaneous metastases to levels III and IV, and tumor deposits (all p < 0.05), but it was not significantly associated with age, sex, tumor location, multifocal lesions, tumor size, local invasion of primary focus, other cervical lymphatic metastasis, TNM staging, and the metastases to more than 5 central lymph nodes (all p > 0.05). Multivariate analysis suggested that the simultaneous metastases to levels III and IV and tumor deposits were the risk factors of level V lymphatic metastasis. Conclusion The simultaneous metastases to levels III and IV and tumor deposits are independent risk factors of level V lymphatic metastasis. The patients with pN1b PTC who have simultaneous metastases to levels III and IV or/and tumor deposits may have the risk of level V lymph node metastasis.
Highlights
Papillary thyroid carcinoma (PTC), a common pathological type, accounts for approximately 85% of thyroid cancer [1]
Univariate analysis indicated that the level V lymphatic metastasis was significantly associated with simultaneous metastases to levels II, III, and IV, simultaneous metastases to levels III and IV, and tumor deposits, but it was not significantly associated with age, sex, tumor location, tumor-multifocal, tumor size, local invasion of primary focus, other cervical lymphatic metastasis, TNM staging, and the metastases to more than 5 central lymph nodes (Table 2)
Discussion e level V lymphatic metastasis is strongly associated with postoperative local tumor recurrence and disease-free survival in PTC [4], but its incidence is relatively low. e level V lymph node dissection may cause accessory nerve and cervical plexus injuries, which may lead to shoulder dysfunction, as well as numbness and neuralgia in the cervical region [6, 7]
Summary
Papillary thyroid carcinoma (PTC), a common pathological type, accounts for approximately 85% of thyroid cancer [1]. In PTC, cervical lymph node metastasis is common with a metastasis rate of as high as 40%–90% [2]. American yroid Association guidelines made in 2015 recommended lateral neck lymph node dissection for the patients with biopsy-confirmed jugular chain lymph node metastasis [5]. It is still controversial whether the patients with lateral neck lymph node metastasis require further level V lymph node dissection. Preoperative ultrasound and CT usually cannot detect level V lymph node metastasis in the patients with PTC. We analyzed the risk factors of level V lymphatic metastasis in the PTC patients with pN1b to provide a reference for making treatment decisions
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