Lymph node metastasis around the entrance point to recurrent laryngeal nerve in papillary thyroid carcinoma

Tian Lv,Jiqi Yan,Zhuoran Liu

doi:10.1038/s41598-020-62031-w

Tian Lv, Jiqi Yan + Show 1 more

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https://doi.org/10.1038/s41598-020-62031-w

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Journal: Scientific Reports	Publication Date: Mar 25, 2020
Citations: 3	License type: open-access

Affiliation: Ruijin Hospital, Shanghai Jiao Tong University

Abstract

There are few reports on the lymph nodes of entrance point to recurrent laryngeal nerve (LN-epRLN) in patients with papillary thyroid carcinoma (PTC). Thus, we investigated the clinical significance of LN-epRLN and implications it may have. An observational analysis of 878 consecutive patients with PTC who underwent thyroidectomy from April 2016 to March 2017 was conducted. We explored the surrounding tissue of laryngeal entry point, during routine central lymph node dissection (CLND). The lymph node specimens were sent separately for routine histopathological examination. Thereafter, complications and follow-ups were recorded. LN-epRLNs were found in 73 of the 878 patients, with the metastatic rate of 3.76%. Univariate and multivariate analysis showed central lymph node metastases can serve as independent predictors for LN-epRLN metastasis. In summary, we confirmed the significance of LN-epRLN in metastasis and recurrence, which required precise anatomy and thorough CLND. In PTC patients, especially in suspicious presence of central cervical lymph node metastasis, attention should be given to excising the nodal tissue at the laryngeal entry point.

Highlights

There are few reports on the lymph nodes of entrance point to recurrent laryngeal nerve (LN-epRLN) in patients with papillary thyroid carcinoma (PTC)
We evaluated a series of patients who underwent thyroidectomies with the aim of highlighting LN-epRLN metastasis in PTC patients
There were two metastatic lesions in the central compartment and the two patients suffered a second operation, which both resulted in the overlooked LN-epRLN

Summary

Introduction

There are few reports on the lymph nodes of entrance point to recurrent laryngeal nerve (LN-epRLN) in patients with papillary thyroid carcinoma (PTC). We explored the surrounding tissue of laryngeal entry point, during routine central lymph node dissection (CLND). In PTC patients, especially in suspicious presence of central cervical lymph node metastasis, attention should be given to excising the nodal tissue at the laryngeal entry point. Advocates of partial central lymph node dissection (CLND) cite the reduction in risks of postoperative complications[2]. Variations in the extent of adhesions around the lymph nodes of entrance point to recurrent laryngeal nerve (LN-epRLN)and neck muscle remnants make identification of the recurrent laryngeal nerve (RLN) and parathyroid glands more difficult compared to primary operation, and risks of certain postoperative complications, such as RLN palsy or hypoparathyroidism, are significantly higher[7]. We evaluated a series of patients who underwent thyroidectomies with the aim of highlighting LN-epRLN metastasis in PTC patients

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