Abstract
Preoperative detection of cervical lymph node metastasis in papillary thyroid carcinoma (PTC) is crucial for determining the surgical strategy to prevent locoregional recurrence of the disease. We identified the cytological predictors of lymph node metastasis in 222 consecutive patients with PTC using fine-needle aspiration cytology (FNAC) of the thyroid. Cervical lymph node metastases occurred in 99 (44.6%) of 222 PTC patients. Lymph node metastasis was significantly associated with tumor multifocality (p = 0.003), and high cellularity (p = 0.021), atypical histiocytoid cells (p < 0.001), and multinucleated giant cells (p < 0.001) in thyroid FNAC. The BRAF V600E mutation was marginally associated with lymph node metastasis (p = 0.054). Multivariate analysis revealed that atypical histiocytoid cells (odds ratio = 2.717; p = 0.001) and multinucleated giant cells (odds ratio = 3.070; p = 0.031) were independent predictors of lymph node metastasis in patients with PTC. In a subgroup analysis of 164 patients with microcarcinomas, atypical histiocytoid cells (odds ratio = 2.761; p = 0.005) was an independent predictor of lymph node metastasis. Cytological detection of atypical histiocytoid cells and multinucleated giant cells on thyroid FNAC can be used to preoperatively predict cervical lymph node metastasis in patients with PTC.
Highlights
Papillary thyroid cancer (PTC) represents 80–90% of all thyroid cancers [1]
We reported that the cytologic features of tall cells were detected in liquid-based cytology but tall cell features alone were not reliable in predicting lymph node metastasis of papillary thyroid carcinoma (PTC) [14]
We found that the presence of atypical histiocytoid cells and multinucleated giant cells in thyroid fine-needle aspiration cytology (FNAC) is a predictive marker for cervical lymph node metastasis
Summary
Cervical lymph node metastasis occurs in 30% to 50% of patients with PTC and is related to local tumor recurrence after cancer surgery, and disease-specific mortality [1,2,3,4]. Preoperative detection of lymph node metastasis is crucial for surgical planning of PTC. Ultrasonography is the best modality for the screening of thyroid nodules and cervical lymph nodes [1,2,5]. Ultrasound-guided fine-needle aspiration cytology (FNAC) has been considered the standard method for preoperative diagnosis of suspicious lymph. Cancers 2019, 11, 816 nodes in PTC patients [1]. Only 20–40% of patients with cervical lymph node metastasis can be preoperatively diagnosed using ultrasonography [6,7,8]
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