Prediction of Ipsilateral and Contralateral Cervical Lymph Node Metastasis in Unilateral Papillary Thyroid Carcinoma

Abstract

Background: Surgical therapy is the cornerstone of treatment in patients with papillary thyroid cancer (PTC). Surgical therapy in PTC includes hemithyroidectomy or total thyroidectomy (TT) and, in cases of lymph node metastases, cervical lymph node dissection (CLND). The inclusion of prophylactic central compartment neck dissection (pCCND) as a new approach in the management of patients with PTC with clinically negative cervical lymph nodes raised controversies among the endocrine surgeons and predictive factors for central lymph node (CLN) metastasis in unilateral PTC cases not well defined. Objectives: To investigate the risk factors associated with CLNM in clinical lateral cervical lymph node?negative (cN0) and analyze the rate of ipsilateral and contralateral CLN metastasis in unilateral PTC casesin Al Azhar University Hospitals in the period from May 2016 tillJune 2018. Patients and Methods: A prospective case-control descriptive study was performed to investigate the research questions during the period from the 1st of May 2016 till the end of June 2018 in Al-Azhar University Hospitals. A total of 40 selected patients suffering from papillary thyroid with clinically negative cervical lymph nodes who have received total thyroidectomy with bilateral CLND. The clinicopathological features of PTC patients with respect to sex, age, observation, tumor diameter, multifocality, extrathyroidal invasion, lymphovascular invasion and capsular invasion. The risk factors of CLNM were analyzed by Chi-squared test and multivariate logistic regression model. Results: Ipsilateral CLN metastasis were present in 47.5% (19/40).Results analysis showed that males patients with tumor size (>1 cm) (P=0.027; OR, 2.153), age <45 years old (P=0.017; OR, 2.009) and capsular invasion (P= 0.018; OR= 0.730) were the predictors of ipsilateral CLN metastasis.Contralateral CLN metastasis were present in 17.5% (7/40) and prelaryngeal lymph node (LN) metastasis (P=0.008; OR, 13.333) and ipsilateral CLN metastasis (P=0.051; OR, 9.231), pretracheal lymph nodes (P=0.051; OR, 9.231), lymphovascular invasion (P=0.043; OR, 5.113) and ETE (P=0.05; OR, 4.901) independently predicted contralateral CLN metastasis. Conclusion: For the high-risk PTC patients with CLNM, prophylactic CLND may be beneficial. Nevertheless, the present data was a single center prospective analysis, and the long-term prognostic factors including recurrence rate and mortality rate were lacking. Therefore, the results of this research may only serve as a tool in predicting CLNM.