Abstract
Simple SummaryThe presence of lateral neck lymph node (LN) metastasis (N1b) is a known prognostic factor for poor prognosis and high morbidity after surgery in papillary thyroid carcinoma (PTC). Previous studies have suggested that tumor size and metastatic LN characteristics, including LN size, number, ratio, and extranodal extension, are associated with recurrence; however, the prognostic role of imaging features of LNs in the lateral neck have rarely been reported. In this study, we investigated whether ultrasound imaging features of lateral neck LN metastases can be prognostic markers for predicting recurrence and thereby guide surgical extent and posttreatment surveillance in N1b PTC.This study aimed to investigate whether preoperative ultrasonographic (US) features of metastatic lymph nodes (LNs) are associated with tumor recurrence in patients with N1b papillary thyroid carcinoma (PTC). We enrolled 692 patients (mean age, 41.9 years; range, 6–80 years) who underwent total thyroidectomy and lateral compartment LN dissection between January 2009 and December 2015 and were followed-up for 12 months or longer. Clinicopathologic findings and US features of the index tumor and metastatic LNs in the lateral neck were reviewed. A Kaplan-Meier analysis and Cox proportion hazard model were used to analyze the recurrence-free survival rates and features associated with postoperative recurrence. Thirty-seven (5.3%) patients had developed recurrence at a median follow-up of 66.5 months. On multivariate Cox proportional hazard analysis, male sex (hazard ratio [HR], 2.277; 95% confidence interval [CI]: 1.131, 4.586; p = 0.021), age ≥55 years (HR, 3.216; 95% CI: 1.529, 6.766; p = 0.002), LN size (HR, 1.054; 95% CI: 1.024, 1.085; p < 0.001), and hyperechogenicity of LN (HR, 8.223; 95% CI: 1.689, 40.046; p = 0.009) on US were independently associated with recurrence. Preoperative US features of LNs, including size and hyperechogenicity, may be valuable for predicting recurrence in patients with N1b PTC.
Highlights
Introduction published maps and institutional affilPapillary thyroid carcinoma (PTC) is the most common malignancy in the head and neck, accounting for 90% of thyroid malignancies [1,2]
Previous studies have reported that tumor size and metastatic lymph nodes (LNs) characteristics including LN size, number, ratio, and extranodal extension are associated with the prognosis of patients with N1b
Of the clinicopathologic characteristics (Table 1), the proportion of male patients was higher in the group of patients with recurrence than in the group of patients without recurrence (31.6% vs. 56.8%; p = 0.002)
Summary
Introduction published maps and institutional affilPapillary thyroid carcinoma (PTC) is the most common malignancy in the head and neck, accounting for 90% of thyroid malignancies [1,2]. PTC frequently shows lymph node (LN) metastasis in the central and lateral neck with a prevalence of approximately. The presence of LN metastasis in the lateral neck, which is staged N1b, has been associated with a high rate of posttreatment recurrence [4,6,7,8]. N1b PTC is known to be related to high morbidity rates due to extensive lateral neck dissection [9,10]. Because of its high recurrence potential and high morbidity rates, risk stratification of PTC N1b is important in patient management, including the determination of the optimal extent of surgery or posttreatment surveillance. Previous studies have reported that tumor size and metastatic LN characteristics including LN size, number, ratio, and extranodal extension are associated with the prognosis of patients with N1b
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