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Abstract
Papillary thyroid carcinomas (PTC) frequently metastasize to regional lymph nodes. Our purpose was to investigate the predictive role of tumor location for lymph node metastasis pattern in PTCs. Medical records of 110 PTC patients were reviewed retrospectively. Tumor location was determined as upper, middle, and lower pole according to ultrasonography (USG) findings. The effects of age, sex, tumor size, and location on lymph node metastasis were investigated. The series comprised 87% females (n = 96) and 13% males (n = 14). Forty-three patients had central neck metastasis (CNM) and 14 had lateral neck metastasis (LNM). Upper pole tumors (UPT) metastasized to the central neck (CN) at a lower rate (17.6%) than middle (40.0%) or lower (48.5%) poles overall (P = 0.104), while it was at a significantly lower rate (13.3%) in the PTC group (P < 0.05). UPTs (n = 17) metastasized to the lateral neck (LN) almost 2-fold more. It was observed that 3 of 4 UPTs spread directly to the LN without CNM. In our opinion, UPTs have propensity to demonstrate metastasis to LN rather than the CN in PTCs. Therefore, UPTs should be evaluated meticulously in terms of LNM. New studies could suggest that CN dissection is not performed for low-risk PTCs in UPTs.
Highlights
Papillary thyroid carcinomas (PTC) constitutes approximately 80%–85% of all thyroid cancers with reported 10-year survival of >90% [1]
New studies could suggest that central neck (CN) dissection is not performed for low-risk PTCs in Upper pole tumors (UPT)
lateral neck dissection (LND) was performed if lateral cervical lymph node metastasis was evident radiologically or confirmed by ultrasound-guided fine needle aspiration biopsy (FNAB) and routinely included neck levels 2, 3, and 4
Summary
PTC constitutes approximately 80%–85% of all thyroid cancers with reported 10-year survival of >90% [1]. Lymph node metastasis may be a risk factor for recurrence and distant metastasis in PTC. In addition to the effects of metastases on survival and recurrence, which are still open to discussion, the effects of many prognostic factors such as age, sex, primary tumor location, size of the tumor, extracapsular spread, and histopathology have become issues in current studies [1,6,7]. Clinical trials about the effects of primary tumor location on lymph node metastasis have provided conflicting results [1,6,7]. Lee et al [7] reported that primary tumors located in the upper pole of the thyroid gland are closely linked to skipped metastases in the lateral cervical neck
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