Central Cervical Lymph Node Research Articles

Clinical Characteristics of Multifocal Papillary Thyroid Carcinoma

Background and Objectives:Papillary thyroid cancers (PTCs) often present as multifocal tumors. Whether multifocal tumors are associated with increased risk of recurrence and mortality is still the subject of controversy. The aim of current study was to indi- vidualize factors associated with multifocality of papillary thyroid cancer and determine the clinical significance of multifocal thy- roid cancer. Subjects and Method:We undertook a retrospective study of 403 patients treated between January, 2003 and June, 2007 for papillary thyroid carcinoma by total thyroidectomy and central compartment neck dissection (n=403) with or without comprehensive lateral neck dissection. There were 342 women and 61 men whose mean age was 47.3 years old. Following criteria were used to study the pattern of and factors related with multifocality:sex, age, extracapsular extension, central compartment lymph node metastasis, the involvement of lateral neck lymph node, AMES risk group, distant metastasis. Results:Of those fac- tors, sex (p=0.0481), central compartment lymph node metastasis (p=0.0007), the involvement of lateral neck lymph node (p=0.0001) were significantly related factors for multifocality of papillary thyroid cancer. Age, primary tumor size, AMES risk group were not significantly related with multifocality. Bilateral or contralateral central compartment lymph node metastasis oc- curred more frequently in multifocal PTCs (64.0%) than solitary PTCs (46.9)(p=0.012). Conclusion:Our data suggest that the multifocal tumors in patients with papillary thyroid carcinoma are associated with increased risk of bilateral central compartment and lateral cervical lymph node metastasis. Therefore, total thyroidectomy and bilateral central compartment lymph node dissection should be recommended as a routine procedure in multifocal papillary carcinoma. (Korean J Otorhinolaryngol-Head Neck Surg 2009;52:512-5)

Surgical treatment of thyroid carcinoma

BACKGROUND: Thyroid cancer is usually of follicular cell origin, but medullary thyroid cancer (MTC) arises from the parafollicular or C-cells. The annual incidence of thyroid cancer varies from 3–7 per 100.000 population in Austria and constitutes 1.36 % of all malignant tumours. METHODS: The current surgical treatment of thyroid carcinoma is reviewed with respect to the endemic epidemiology. RESULTS: Four distinct histological types of follicular cell-derived cancers are recognized, approximately two-thirds are papillary, one-third is follicular, some are oxyphilic cancers and the anaplastic type has become rare lately. The first three types are summed up as differentiated thyroid carcinomas (DTCs). MTC is rare and constitutes 6–7 % of thyroid cancers, of which approximately 75 % are sporadic and 25 % are hereditary. There are no prospective, randomised trials to determine the "optimal treatment" of the various thyroid carcinomas. The "failed TNM classification" in its sixth edition again demolished studies over a longer period, as the fifth and sixth editions were only five years apart and classification does not match. At least in endemic areas surgery should be more radical, as tumour biology seems to be more aggressive and the patients are mainly in the higher risk groups. Therefore total thyroidectomy is the operation of choice for pre- or intraoperatively diagnosed DTCs and MTCs. Less than radical surgery should only be performed for tumours smaller than 10 mm without obvious multicentricity. Central cervical lymph node dissection is mandatory in all operations with pre- or intraoperatively determined cancer. If there is evidence of clinical or pathological central lymph node metastases, an uni- or bilateral neck dissection should be accomplished. Only in patients with occult or incidentally found papillary carcinomas of less than 10 mm completion thyroidectomy and lymph node dissection can be omitted. CONCLUSIONS: As there are no controlled randomized studies, developing guidelines is difficult, especially as data from other parts of the world do not necessarily apply for endemic regions, such as Austria. It is generally agreed that patients with DTC and MTC should be treated by total thyroidectomy with adequate lymph node dissection. Patients can usually be discharged after 2 or 3 days after these procedures, and morbidity for RLNP and postoperative hypoparathyroidism is low when thyroidectomy is performed by an experienced thyroid surgeon. As age >45 years and increasing tumour size predict poor prognosis in DTCs, new means of diagnosis for earlier treatment are therefore necessary. Hereditary MTCs should only be treated in multidisciplinary study groups according to their genetic risk.

Clinicopathological studies of minimal thyroid and ordinary thyroid cancers.

Clinicopathological studies were carried out on 27 patients with minimal thyroid cancer and 56 with ordinary thyroid cancer at Kanazawa University, from April, 1979 to December, 1982. There was a significant difference in the rate of preoperative diagnosis between the minimal and the ordinary cancer groups. Subtotal thyroidectomy with modified neck dissection was usually performed in both groups. The histological types in minimal cancer group included 16 papillary carcinomas, 7 nonencapsulated sclerosing carcinomas, one follicular carcinoma, one anaplastic carcinoma with squamous cell metaplasia and two multiple mixed carcinomas. There was no significant difference in the rates of intrathyroidal and lymph node metastases between the two groups. While the metastatic lesions of sclerosing carcinoma were localized to the central cervical lymph nodes, the ordinary cancer in general and the papillary variant of minimal cancer metastasized not only to the central cervical lymph nodes but also to the ipsilateral and even to the contralateral jugular lymph nodes.