Abstract
BackgroundTo evaluate the possible predictive value and clinicopathological characteristics of Delphian lymph node metastasis in papillary thyroid carcinoma.MethodsA retrospective analysis of papillary thyroid carcinoma patients with Delphian lymph node metastasis in a single institution and meta-analysis of literature reports were performed.ResultsIn own series, Delphian lymph node metastasis was detected in 19 (9.9%) of 192 papillary thyroid carcinoma patients and was significantly associated with tumor size≥1 cm (P = 0.003), multifocality (P = 0.006) and extrathyroid extension (P < 0.001) in the multivariate analysis. Female was a protective factor for Delphian lymph node metastasis (P = 0.001). Delphian lymph node metastasis was highly predictive of further central lymph node metastasis (positive predictive value = 89.5%, negative predictive value = 67.6%) and moderately predictive of lateral lymph node metastasis (positive predictive value = 26.3%, negative predictive value = 95.4%). In this meta-analysis, there was a strong correlation between Delphian lymph node metastasis and aggressive clinicopathologic characteristics with regards to multifocality (P = 0.0008), bilaterality (P = 0.04), extrathyroid extension (P < 0.00001), lymphovascular invasion (P < 0.00001), further central lymph node metastasis (P < 0.00001) and lateral lymph node metastasis (P < 0.00001).ConclusionsThis single-institution observational study and meta-analysis identified that Delphian lymph node metastasis was significantly associated with unfavorable clinicopathological characteristics and had a strong predictive power for further disease in the central compartment.Trial registrationThe clinical study was retrospectively registered to UMIN clinical trials registry (the registry number: UMIN000033835).
Highlights
The Delphian lymph node (DLN), called the prelaryngeal or cricothyroid node, locates in the fascia above the thyroid isthmus and lies between the cricoid and thyroid cartilages [1, 2]
Because of inconsistent results and lack of meta-analyses to systematically review the significance of the DLN in papillary thyroid carcinoma (PTC), we report the outcomes of a single-institution case series and present the first meta-analysis of the clinical characteristics of PTC patients with DLN metastasis
Single-institution observational study We retrospectively reviewed the medical records of 192 patients with a final diagnosis of PTC who underwent total thyroidectomy and central lymph node dissection (CLND) with or without lateral lymph node dissection (LLND) in Shanghai Changzheng Hospital (Shanghai, China) between July 2017 and August 2018
Summary
The Delphian lymph node (DLN), called the prelaryngeal or cricothyroid node, locates in the fascia above the thyroid isthmus and lies between the cricoid and thyroid cartilages [1, 2]. Wang et al Journal of Otolaryngology - Head and Neck Surgery (2019) 48:42 papillary thyroid carcinoma (PTC) [10,11,12,13,14,15,16,17,18] and most of these studies were published in recent years. The clinical data from some studies indicate that DLN metastasis is a predictor of further disease in the central compartment and in the lateral compartment. Some investigators contended that the DLN is frequently found without extensive lymph node disease and even argued that DLN involvement is a misleading and unreliable sign [19, 20]. To evaluate the possible predictive value and clinicopathological characteristics of Delphian lymph node metastasis in papillary thyroid carcinoma
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