Abstract
BackgroundCentral and lateral lymph node metastases are quite common in patients with papillary thyroid carcinoma, and the predictors for those metastases have been well studied. Right upper paraesophageal lymph node metastasis has rarely been studied. The aim of this study was to identify the clinicopathological characteristics that may be risk factors for right upper paraesophageal lymph node metastasis in patients with papillary thyroid carcinoma.MethodsThis was a prospective observational study of 243 patients with papillary thyroid carcinoma (PTC) who underwent total thyroidectomy and comprehensive central lymph node dissection with or without lateral lymph node dissection between April 2008 and January 2010. The clinicopathologic findings from these patients were investigated and the patterns of lymph node metastasis were analyzed in the patients who had right upper paraesophageal lymph node disease.ResultsOf the 243 patients undergoing lymph node dissection, 14 had right upper paraesophageal lymph node metastases. Two of these patients had right upper paraesophageal lymph node metastasis only, without central compartment metastasis. Univariate analysis of clinicopathologic findings showed that right upper paraesophageal lymph node metastasis had significant association with larger primary tumors, multifocal tumors, extrathyroid extension, and lymphatic invasion (p <0.05 for each factor).ConclusionsAlthough there were no independent predictors of right upper paraesophageal lymph node metastasis, it can be the only site of metastasis without other compartmental metastasis. Therefore, during surgery for patients with central or lateral lymph node metastases from PTC, it may be helpful to examine the right upper paraesophageal lymph nodes.
Highlights
Central and lateral lymph node metastases are quite common in patients with papillary thyroid carcinoma, and the predictors for those metastases have been well studied
Other authors have recommended total thyroidectomy with central lymph node dissection because a high rate of locoregional recurrence and distant metastasis from Papillary thyroid carcinoma (PTC) may decrease survival, and preoperative assessment of the central compartment by US [15,16,17,18] is less sensitive than lateral compartment ultrasound
Most series have reported a higher rate of nodal disease in the central compartment and lateral neck than in the mediastinum [7,19]; right upper paraesophageal lymph node metastasis posterior to the right recurrent laryngeal nerve is associated with superior mediastinal lymph node metastasis and is a risk for invasion of the mediastinal organs, including the trachea [20,21]
Summary
Central and lateral lymph node metastases are quite common in patients with papillary thyroid carcinoma, and the predictors for those metastases have been well studied. Right upper paraesophageal lymph node metastasis has rarely been studied. The aim of this study was to identify the clinicopathological characteristics that may be risk factors for right upper paraesophageal lymph node metastasis in patients with papillary thyroid carcinoma. Papillary thyroid carcinoma (PTC) is the most common form of thyroid cancer. Cervical lymph node metastases are quite common in PTC and have been found in 20% to 50% of patients. Lymph node metastases are known to be important prognostic factors for locoregional and distant metastasis [2,3,4]. Local recurrence in the central compartment after initial surgery has been reported to increase mortality rates [5]
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