Central Neck Lymph Node Research Articles

Evaluation of Positive Predictors of Micrometastasis in Central Lymph Nodes in Patients with Papillary Thyroid Cancer; A Cross-Sectional Study.

Papillary thyroid cancer (PTC) is the most common primary cancer originating from thyroid follicular cells. The aim of this study was to evaluate the positive predictors of micrometastasis in central lymph nodes in patients with papillary thyroid cancer. This was a cross-sectional study. The study population was all known PTC patients who underwent total thyroidectomy and lymph node dissection of the central neck nodes based on the current indications. Confirmation of central lymph node involvement was performed by permanent smear after surgery. Data were analyzed using SPSS software version 22. A P-value below 0.05 was considered statistically significant. There was no significant relationship between age, gender, family history of PTC, family history of thyroid disease, multinodularity, history of other thyroid diseases, involvement of two thyroid lobes, and tumor grade with central lymph node involvement (P>0.05). There was a significant relationship between the tumor pathology and size with central lymph node involvement (P<0.05). Moreover, logistic multivariate regression analysis showed that female gender, multinodularity, and tumor size had a significant relationship with the incidence of central lymph node involvement (P<0.05). Female gender, multinodularity, and larger tumor size may be predictors of micrometastasis in central lymph nodes in patients with papillary thyroid cancer.

The Association of Cervical Lymph-Node with Thyroid Papillary Carcinoma, Case Report

The association of cervical adenopathie with a cervical carcinoma location suggests a lymph node metastasis and requires a complicated and radical surgery. The most common location of extrapulmonary tuberculosis is cervical lymph nodes (63-77%) [1]. We report a tuberculous lymphadenetis mimicking lymph node metastasis in a 35-year-old patient operated for progressive cervical tumefaction. It was a papillary thyroid carcinoma found after an isthmo-lobectomy. The pathologic findings imposed a thyroidectomy totalization and an ipsilateral central neck lymph node dissection. The operatory finding of a controlateral adenopathy manly with the development of a controlateral cervical adenopathie suggesting lymph node metastatic extension. A lymph node excision was undertaken and the pathologic study revealed a tuberculous lymphadenitis. The patient was treated by put under antibacillary treatment and evolution was satisfactory. We also expose, through this work, a certain number of techniques of exploration likely to ascertain the diagnosis of a tuberculous lymphadenitis and to monitor the therapeutic strategy.

Risk factors for central neck lymph node metastasis in patients with macro and micropapillary thyroid carcinoma

Risk factors for central neck lymph node metastasis in patients with macro and micropapillary thyroid carcinoma

Aggressiveness of Differentiated Thyroid Carcinoma in Pediatric Patients Younger Than 16 years: A Propensity Score-Matched Analysis.

BackgroundThe biological behavior of thyroid cancer in children has been known to be different from that in adults. We sought to understand the differences between DTC presentation in pediatric (<16 years) and adult patients, to guide better prognosis and clinical treatments.MethodsThis retrospective study included 48 pediatric patients younger than 16 years who underwent initial thyroid surgery and were diagnosed with DTC between January 1992 and December 2014 at Yonsei University in Seoul, South Korea. For a 1:4 propensity score-matched analysis, adult patients with matched sex and cancer size were included.ResultsThe mean age was 12.54 ± 3.01 years. Total thyroidectomy (70.8%) without lateral lymph node dissection (47.9%) was the most commonly performed surgery. Central (73.9%) and lateral neck node metastases (62.5%) were common; distant metastasis was observed in 2 (4.2%) patients and recurrence occurred in 11 (22.9%). In propensity score-matched analysis, central lymph node metastasis and lateral neck node metastasis were significantly more frequent in pediatric patients. Symptoms were more common in the pediatric group than in the adult group (p < 0.001). In stratified cox regression, pediatric patients were more likely to experience recurrence [HR 5.339 (1.239–23.007)]. In stratified log-rank analysis, recurrence-free survival was significantly different between the adult and pediatric groups (p = 0.0209).ConclusionDTC in the pediatric group revealed more aggressive patterns than in the adult group with the same cancer size. Central lymph node metastasis and lateral neck node metastasis were more frequent. Stratified log-rank analysis revealed that recurrence was significantly higher in pediatric patients than in matched adult patients.

Preoperative prediction of central lymph node metastasis in cN0T1/T2 papillary thyroid carcinoma: A nomogram based on clinical and ultrasound characteristics

BackgroundPreoperative status of central lymph nodes is a key determinant of the initial surgical extent for papillary thyroid carcinoma (PTC). We aimed to develop and validate a nomogram based on preoperative clinical characteristics and ultrasound features to predict central lymph node status in patients with clinically lymph node-negative (cN0) T1/T2 PTC. MethodsThis retrospective study included 729 patients with cN0T1/T2 PTC who were treated between January 2015 and March 2020. Based on the ratio of 6:4, 431 patients who underwent surgeries relatively earlier comprised the training set to develop the nomogram, while the other 298 who underwent surgeries relatively later comprised validation set to validate the performance of nomogram. Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression were used to identify predictors of central lymph node metastasis (CLNM). These variables were used to construct a nomogram for predicting the risk of CLNM. The predictive performance, discriminative ability, calibration, and clinical utility of the nomogram model were evaluated in both sets. ResultsA total of 313 (42.9%) PTC patients were identified with CLNM. On multivariate logistic regression analyses, malegender, younger age, larger maximum diameter, multifocality, capsular invasion, infiltrative margins, intra-nodular vascularity, and aspect ratio >1 were independent risk factors for CLNM. Nomogram integrating these 8 factors showed excellent discrimination in the training [area under the curve (AUC): 0.788] and validation (AUC: 0.829) sets, and obtained well-fitted calibration curves. The cut-off value of this nomogram was 0.410 (∼245 points). Decision curve analysis confirmed the clinical utility of the nomogram. ConclusionThe CLNM-predicting nomogram can facilitate stratification of cN0T1/T2 PTC patients. Prophylactic central neck lymph node dissection can be considered for those with high nomogram scores.

Prophylactic central lymph node dissection performed selectively with cN0 papillary thyroid carcinoma according to a risk-scoring model.

This study aimed to explore the risk factors of central lymph node metastasis (CLNM) in patients with clinical central lymph node-negative papillary thyroid carcinoma (PTC), and emphasize the guidance of the risk scoring model for prophylactic central lymph node dissection (pCLND) in patients with clinical lymph node-negative (cN0) PTC. A total of 582 patients with cN0 PTC who underwent unilateral/bilateral thyroidectomy and prophylactic central lymph node dissection (pCLND) in the Affiliated Hospital of Nantong University from January 2020 to February 2021 were retrospectively analyzed. Univariate and multivariate analyses were performed to determine the risk factors of cN0 PTC. According to the independent risk factors of patients with cN0 PTC, a risk-scoring model was established. Then, the rationality of this risk scoring model was verified by additional clinical data of 112 patients with cN0 PTC in the Affiliated Hospital of Nantong University from March 2021 to April 2021. Among 582 cases of cN0 PTC, 53.6% of the patients with cN0 had CLNM. The independent risk factors for CLNM in patients with cN0 PTC included male gender, <45 years of age, tumor with a maximum diameter of ≥1.0 cm, tumor location: middle/lower poles of the thyroid gland, multifocality, and extrathyroidal extension (ETE), and some ultrasound features, such as intra-nodular vascularity, microcalcification, irregular shape, and infiltrative margin. According to independent risk factors, a 24-point risk scoring model was established to predict CLNM in patients with cN0 PTC. Currently, prophylactic central neck lymph node dissection is a controversial operation, which should be selectively performed only for high-risk patients with cN0 PTC. For cN0 PTC patients with scores ≥14 and high-risk patients, even if no CLNM is found before surgery, routine prophylactic CLND is recommended. In addition, for cN0 PTC patients with a score of fewer than 14 points, it is recommended to perform fine-needle aspiration (FNA) before surgery, carefully assess the condition of the central lymph nodes, and then select the best surgical plan based on the results of the assessment.

Management of lateral neck nodes in common and aggressive variants of thyroid cancer.

Although nodal metastasis in thyroid cancer does not have a major impact on outcome, it does have some prognostic implication in adverse metastasis and aggressive histology. The purpose of this review is to discuss evaluation and management of lateral neck nodes in thyroid cancer. There is a high incidence of central and lateral neck node metastasis in thyroid cancer. Appropriate preoperative evaluation is key prior to first surgical procedure. The distribution of nodal metastasis is well recognized and so generally a modified neck dissection is recommended from levels II through V. The risk of nodal metastasis at level IIb is rare. The complications of lateral neck dissection, though rare, are of significant importance to the quality of life. Appropriate preoperative evaluation, including good ultrasound and CT scan with contrast, is recommended. Preoperative FNA of the lateral neck node will be helpful, along with thyroglobulin management if indicated. The neck dissection should include significant levels of neck, avoiding neural injury. Nonsurgical therapies may be recommended in selected patients.

Prophylactic Central Neck Lymph Node Dissection in Low-risk Thyroid Carcinoma Patients Does Not Decrease the Incidence of Locoregional Recurrence: A Meta-analysis of Randomized Trials.

To evaluate the effectiveness of T + prophylactic CND (T+CND) compared to T alone on locoregional recurrence in patients with PTC. Few RCTs have assessed the risks and benefits of prophylactic CND in patients with PTC. Most recommendations are still based on meta-analyses that include observational studies, which are prone to selection bias. We included RCTs involving adult patients with clinically negative neck (cN0) PTC that compared T versus T+CND. The main outcomes assessed were structural and biochemical recurrence and complications. For methodological quality assessment, we used the Revised Cochrane risk-of-bias tool for randomized trials instrument, and for robustness, we used the fragility index. Five RCTs with 763 patients were included (354 in the T group and 409 in the T+CND group). Most studies were classified as having a low risk of bias. Publication bias was not found. Structural recurrence occurred in 11/409 (2.7%) patients in the T+CND group and 9/354 (2.5%) patients in the T group, with a risk difference (RD) =0% [95% confidence interval (CI) -2% to 2%]. For biochemical recurrence, the RD was 0% (95% CI -5% to 4%). The number needed to treat was 500. The rate of permanent hypoparathyroidism was higher in the T+CND group than in the T group [RD 3% (95% CI 0%-6%)]. We did not find a beneficial effect of prophylactic CND associated with T on locoregional or biochemical recurrence but did confirm a higher risk of permanent hypoparathyroidism associated with this procedure.

Predictive Factors for Skip Lymph Node Metastasis and Their Implication on Recurrence in Papillary Thyroid Carcinoma.

Skip lymph node (LN) metastases in papillary thyroid carcinoma (PTC) belong to N1b classification in the absence of central neck LN involvement. This study aimed to evaluate the predictive factors of skip metastases and their impact on recurrence in PTC patients with pN1b. A total of 334 PTC patients who underwent total thyroidectomy with LN dissection (central and lateral neck compartment) followed by radioactive iodine ablation were included. Patients with skip metastases tended to have a small primary tumor (≤1 cm) and single lateral neck level involvement. Tumor size ≤ 1 cm was an important predictive factor for skip metastases. Univariate analysis for recurrence showed that patients with a central LN ratio > 0.68, lateral LN ratio > 0.21, and stimulated thyroglobulin (Tg) levels > 7.3 ng/mL had shorter RFS (recurrence-free survival). The stimulated Tg level was associated with shorter RFS on multivariate analysis (>7.3 vs. ≤7.3 ng/mL; hazard ratio, 4.226; 95% confidence interval, 2.226−8.022; p < 0.001). Although patients with skip metastases tended to have a small primary tumor and lower burden of lateral neck LN involvement, there was no association between skip metastases and RFS in PTC with pN1b. Stimulated Tg level was a strong predictor of recurrence.

Thyroid Lobectomy for T1 Papillary Thyroid Carcinoma in Pediatric Patients

The current recommendation for pediatric patients with papillary thyroid cancer (PTC) is a total thyroidectomy. This recommendation applies to all stages of PTC, including papillary thyroid microcarcinoma (≤1 cm, T1a) tumors. To evaluate the characteristics of American Joint Committee on Cancer T1 PTC tumors in a large pediatric population and to identify a subgroup of patients who may benefit from a thyroid lobectomy instead of a total thyroidectomy. This retrospective cohort study was conducted from January 1, 2009, to May 31, 2020. The study took place at a tertiary care medical center and included 102 patients who were surgically treated for T1 PTC: 52 with stage T1a (≤1 cm) tumors and 50 with stage T1b (>1 cm but ≤2 cm) tumors. Primary outcomes included the presence of bilateral disease and lymph node metastasis. A total of 102 patients (mean age, 15.3 years [range, 9.7-18.9 years]; 84 girls [82.4%]) were included in the analysis. Among 52 patients with T1a tumors, 10 (19.2%) had bilateral disease, and 15 (28.8%) had central neck lymph node (N1a) metastasis. Among 50 patients with T1b tumors, 10 (20%) had bilateral and 13 (26%) had N1a disease. Of those with T1a, unilateral multifocality was associated with bilateral disease (odds ratio [OR], 2.1; 95% CI, 1.3-3.4) and N1a disease (OR, 5.1; 95% CI, 1.5-17.6). Both N1a disease (OR, 20.0; 95% CI, 3.5-115.0) and ≥4 positive lymph nodes (OR, 8.6; 95% CI, 1.2-60.9) were associated with bilateral disease. In patients with no pathologic evidence of lymph node metastasis (N0), there was a 95% rate of unilateral PTC. In patients with T1b tumors, unilateral multifocality was also associated with bilateral disease (OR, 1.8; 95% CI, 1.3-2.7). Patients with T1b tumors had an increased risk of lateral (N1b) neck lymph node metastasis when compared with those with T1a tumors (OR, 3.7; 95% CI, 1.0-14.5). The findings of this cohort study suggest that, in patients with unifocal T1a PTC without clinically evident nodal disease on preoperative ultrasonography, a thyroid lobectomy and central neck dissection may be considered. If there is no evidence of unilateral multifocality or if there are fewer than 4 positive lymph nodes on postoperative pathology, then close observation may be considered. These findings have substantial clinical implications and may result in practice changes regarding the extent of thyroid surgery on low-stage pediatric PTC.

Co-Occurrence of Familial Non-Medullary Thyroid Cancer (FNMTC) and Hereditary Non-Polyposis Colorectal Cancer (HNPCC) Associated Tumors-A Cohort Study.

Familial non-medullary thyroid cancer (FNMTC) is a form of endocrine malignancy exhibiting an autosomal dominant mode of inheritance with largely unknown germline molecular mechanism. Hereditary nonpolyposis colorectal cancer syndrome (HNPCC) is another hereditary autosomal dominant cancer syndrome which, if proven to be caused by germline mutations in mismatch repair genes (MMR)—MLHL, MSH2, MSH6, PMS2, and EPCAM—is called Lynch syndrome (LS). LS results in hereditary predisposition to a number of cancers, especially colorectal and endometrial cancers. Tumors in LS are characterized by microsatellite instability (MSI) and/or loss of MMR protein expression in immunohistochemistry (IHC). MSI is a rare event in thyroid cancer (TC), although it is known to occur in up to 2.5% of sporadic follicular TC cases. There are limited data on the role of germline MMR variants FNMTC. The goal of this study was to analyze the potential clinical and molecular association between HNPCC and FNMTC. We performed a cohort study analyzing the demographic, clinical, and pathologic data of 43 kindreds encompassing 383 participants (104 affected, 279 unaffected), aged 43.5 [7-99] years with FNMTC, and performed high-throughput whole-exome sequencing (WES) of peripheral blood DNA samples of selected 168 participants (54 affected by FNMTC and 114 unaffected). Total affected by thyroid cancer members per family ranged between 2 and 9 patients. FNMTC was more prevalent in women (68.3%) and characterized by a median tumor size of 1.0 [0.2-5.0] cm, multifocal growth in 44%, and gross extrathyroidal extension in 11.3%. Central neck lymph node metastases were found in 40.3% of patients at presentation, 12.9% presented with lateral neck lymph node metastases, and none had distant metastases. Family history screening revealed one Caucasian family meeting the clinical criteria for FNMTC and HNPCC, with five members affected by FNMTC and at least eight individuals reportedly unaffected by HNPCC-associated tumors. In addition, two family members were affected by melanoma. Genome Analysis Tool Kit (GATK) pipeline was used in variant analysis. Among 168 sequenced participants, a heterozygous missense variant in the MSH2 gene (rs373226409; c.2120G>A; p.Cys707Tyr) was detected exclusively in FNMTC- HNPCC- kindred. In this family, the sequencing was performed in one member affected by FNMTC, HPNCC-associated tumors and melanoma, one member affected solely by HNPCC-associated tumor, and one member with FNMTC only, as well as seven unaffected family members. The variant was present in all three affected adults, and in two unaffected children of the affected member, under the age of 18 years, and was absent in non-affected adults. This variant is predicted to be damaging/pathogenic in 17/20 in-silico models. However, immunostaining performed on the thyroid tumor tissue of two affected by FNMTC family members revealed intact nuclear expression of MSH2, and microsatellite stable status in both tumors that were tested. Although the MSH2 p.Cys707Tyr variant is rare with a minor allele frequency (MAF) of 0.00006 in Caucasians; it is more common in the South Asian population at 0.003 MAF. Therefore, the MSH2 variant observed in this family is unlikely to be an etiologic factor of thyroid cancer and a common genetic association between FNMTC and HNPCC has not yet been identified. This is the first report known to us on the co-occurrence of FNMTC and HNPCC. The co-occurrence of FNMTC and HNPCC-associated tumors is a rare event and although presented in a single family in our large FNMTC cohort, a common genetic background between the two comorbidities could not be established.

Correlation between US-FNAC with BRAF V600E Mutation Analysis and Central Neck Lymph Node Metastasis in cN0 Papillary Thyroid Cancer.

The aim of this study was to explore the correlation between ultrasound-guided fine-needle aspiration cytology(US-FNAC) combined with BRAF V600E mutation analysis and central neck lymph node metastasis in cN0 papillary thyroid cancer, so as to provide reliable molecular evidence to use it for preoperative evaluation, operation procedure design, and postoperative follow-up planning in clinic. Specimens were obtained from 250 patients with cN0 thyroid cancer (TI-RADS≥4a, highly suspected of PTC by US-FNAC) after bilateral thyroidectomy and central neck lymph node dissection with accessible postoperative pathologic results of PTC and central neck lymph nodes and used for cytological diagnosis by H&E stain and BRAF V600E mutation detection. Single-factor analysis showed that differences between the central neck lymph node metastasis and nonmetastasis groups were statistically significant in gender, BRAF V600E mutation, and extracapsular extension. Logistic multivariate regression analysis showed significant differences in gender, BRAF V600E mutation, and extracapsular extension. Positive BRAF V600E mutations by US-FNAC, extracapsular extension, and male gender are risk factors of central neck lymph node metastasis in cN0 PTC metastatic PTC to central neck lymph node. Patients with those factors should undergo prophylactic central neck lymph node dissection.

A Prediction Model for Contralateral Central Neck Lymph Node Metastases in Unilateral Papillary Thyroid Cancer.

The health problems caused by the frequent relapse of papillary thyroid carcinoma (PTC) remain a worldwide concern since the morbidity rate of PTC ranks the highest among thyroid cancers. Residues from contralateral central lymph node metastases (con-CLNM) are the key reason for persistence or recurrence of unilateral papillary thyroid carcinoma (uni-PTC); however, the ability to assess the status of con-CLNM in uni-PTC patients is limited. To clarify the risk factors of con-CLNM, a total of 250 patients with uni-PTC who underwent total thyroidectomy and bilateral central lymph node dissection were recruited in this study. We compared the clinical, sonographic, and pathological characteristics of patients with con-CLNM to those without con-CLNM and established a nomogram for con-CLNM in uni-PTC. We found that male sex, without Hashimoto's thyroiditis, present capsular invasion, with ipsilateral lateral lymph node metastases, and the ratio of ipsilateral central lymph node metastases ≥0.16 were independent con-CLNM predictors of uni-PTC (ORs: 2.797, 0.430, 2.538, 2.202, and 26.588; 95% CIs: 1.182–6.617, 0.211–0.876, 1.223–5.267, 1.064–4.557, and 7.596–93.069, respectively). Additionally, a preoperative nomogram for the prediction of con-CLNM based on these risk factors showed good discrimination (C-index 0.881; 95% CI: 0.840–0.923; sensitivity 85.3%; specificity 76.0%) and good agreement via the calibration plot. Our study provided a way to quantitatively and accurately predict whether con-CLNM occurred in patients with uni-PTC, which may guide surgeons to evaluate the nodal status and perform tailored therapeutic central lymph node dissection.

A Co-Occurrence of Familial Non-Medullary Thyroid Cancer and Lynch Syndrome

Abstract Background: Lynch syndrome (LS) is an autosomal dominant disease caused by germline mutations in mismatch repair genes (MMR), leading to the early manifestation of tumors characterized by microsatellite instability (MSI) in &amp;gt;3 family members across at least 2 generations. MSI is a rare event in thyroid cancer (TC), occurring in up to 2.5% of sporadic cases. There is limited data on germline MMR variants’ role in familial non-medullary thyroid cancer (FNMTC). The goal of this study was to analyze the potential clinical and molecular association between LS and FNMTC. Material and Methods: We performed a cohort study analyzing the demographic, clinical, and pathologic data of 43 kindreds with FNMTC. We performed a high-throughput whole exome sequencing (WES) of peripheral-blood DNA samples of 168 participants (54 affected by FNMTC and 140 unaffected). The GATK pipeline was used in variant analysis. The NIH Institutional Review Board approved the study. Results: The study included 383 family members (104 affected, 279 unaffected) aged 43.5 [7-99] years, with 2-9 members per family affected by FNMTC. FNMTC was more prevalent in women (68.3%) and characterized by a median tumor size of 1 [0.2-5] cm, multifocal growth in 44%, gross extrathyroidal extension in 11.3%, central neck lymph node metastases in 40.3%, lateral neck lymph node metastases in 12.9% of patients, and no distant metastases. Family history screening revealed one family of Caucasian descent meeting the clinical criteria for FNMTC and LS diagnosis with 5 members affected by FNMTC and 8 individuals by Lynch-like tumors (3 with colorectal cancer/colon polyps, 2 with endometrial or ovarian tumors, 1 with kidney cancer, 1 with keratoacanthoma and 1 with unspecified Lynch-like tumors with detailed pathology report unavailable). We performed whole exome sequencing of 10 members from this family (3 affected and 7 unaffected) and remaining 158 study participants and detected exclusively in this family, a heterozygous missense variant rs373226409, in MSH2 gene c2120G&amp;gt;A (pCys707Tyr) in three adults affected by LS-like manifestations and two unaffected children under the age of 18 with clear segregation across three generations. This variant appears to be relatively rare with a minor allele frequency (MAF) of 0.0006 in Caucasians; however, it is more common in the South Asian population at 0.003 MAF. Immunostaining performed on the TC tumor tissue of one of the affected family members revealed intact nuclear expression of MSH2, suggestive of no major effect of the variant on MSH2 expression. Five out of seven in-silico models predicted the variant to be functionally deleterious. Conclusion: The co-occurrence of LS and FNMTC is a rare event, presenting in 2% (1/43) of families in our cohort. A common genetic association between LS and FNMTC has not been identified, and the MSH2 variant observed in this family is unlikely to be an etiologic factor.

Dysregulation of microRNAs as the risk factor of lymph node metastasis in papillary thyroid carcinoma: systematic review.

Papillary thyroid carcinoma (PTC) has an excellent prognosis with a relatively low mortality rate, but a small portion of PTC patients suffer from an aggressive form of the disease. In such cases early detection of lymph node metastasis (LNM) is as paramount as it is problematic. The routine use of central neck lymph node dissection is not recommended. New methods to detect LNM are needed. MicroRNAs are a potential biomarker for diagnosis and prognosis of PTC. In this review we summarise the current knowledge regarding dysregulated miRNAs and their association with LNM in PTS patients. The PubMed and EBSCO databases were searched using terms for "microRNA", "thyroid carcinoma", and "prognosis" by using Boolean operators. Based on eligibility and exclusion criteria, articles were screened and reviewed in full, methodological data of included studies were extracted, and risk of bias analysis performed. In total, 446 unique studies were extracted from the mentioned databases, and based on inclusion and exclusion criteria 27 studies were included in this review. Of them 17 analysed tissue microRNAs, 5 analysed circulating microRNAs, and 5 studies analysed both tissue and circulating samples. MiRNA-146B, miRNA-221, miRNA-222, miRNA-21, miRNA-204, miRNA-451, miRNA-199a-3p, and miRNA-30a-3p were dysregulated in at least 2 separate studies. A sizable portion of studies failed to show statistically significant differences in miRNA expression between LNM-positive and -negative patients. Different methodologies and disparities of patient populations could explain these discrepancies.\ This research supports the statement that specific up- and downregulated miRNAs are associated with LNM in PTC patients. However, the prognostic value of these miRNAs is limited. Additional targeted cohort studies are required to elucidate the role of miRNAs in defining individualised treatment strategies for thyroid cancer patients.

Metastases of papillary radioiodine-refractory thyroid cancer in the parapharyngeal lymph node: clinical case

Introduction. Papillary thyroid cancer (PTC) usually metastasizes into the central and lateral lymph nodes (LNs) of the neck. Metastases into the retropharyngeal and parapharyngeal LNs are rare. Their presence attests to aggressive PTC.The study objective is to describe a rare case of metastases of papillary radioiodine-refractory PTC into the parapharyngeal LN.Clinical case. In 2015, female patient K., 40 years old, underwent thyroidectomy due to PTC. Histological examination verified papillary PTC with growth through the capsule and ingrowth into the surrounding tissues and muscles. In a separately admitted LN, metastases of the same cancer were observed. One year later, regional metastases in the lateral neck LNs were detected. Radioiodine therapy (activity 131I 4.5 GBq) was performed followed by fascial circular section of the neck tissues on the right per thyroid type. Morphological examination verified presence of papillary PTC metastases in 4 LNs. In January of 2018, positron emission tomography showed metastases in the paratracheal LNs. Central neck lymph node dissection was performed. Per histological conclusion, fat tissue and LN contained multiple metastases of papillary PTC. In October of the same year, repeat radioiodine therapy (activity 131I 3.0 GBq) was performed. Thyroglobulin levels increased. In June of 2020, repeat positron emission tomography showed a single metastasis in the parapharyngeal LN. Due to small size of the metastasis and absence of signs of progression, dynamic follow-up and hormone therapy were suggested to the patient.Conclusion. Metastatic involvement of parapharyngeal LNs is rare, especially in radioiodine-refractory PTC. They can be detected both during primary diagnosis and after the treatment during dynamic follow-up, as well as a single manifestation of PTC, which should be taken into account during differential diagnosis.

Application of Machine Learning Algorithms to Predict Central Lymph Node Metastasis in T1-T2, Non-invasive, and Clinically Node Negative Papillary Thyroid Carcinoma.

Purpose: While there are no clear indications of whether central lymph node dissection is necessary in patients with T1-T2, non-invasive, clinically uninvolved central neck lymph nodes papillary thyroid carcinoma (PTC), this study seeks to develop and validate models for predicting the risk of central lymph node metastasis (CLNM) in these patients based on machine learning algorithms.Methods: This is a retrospective study comprising 1,271 patients with T1-T2 stage, non-invasive, and clinically node negative (cN0) PTC who underwent surgery at the Department of Endocrine and Breast Surgery of The First Affiliated Hospital of Chongqing Medical University from February 1, 2016, to December 31, 2018. We applied six machine learning (ML) algorithms, including Logistic Regression (LR), Gradient Boosting Machine (GBM), Extreme Gradient Boosting (XGBoost), Random Forest (RF), Decision Tree (DT), and Neural Network (NNET), coupled with preoperative clinical characteristics and intraoperative information to develop prediction models for CLNM. Among all the samples, 70% were randomly selected to train the models while the remaining 30% were used for validation. Indices like the area under the receiver operating characteristic (AUROC), sensitivity, specificity, and accuracy were calculated to test the models' performance.Results: The results showed that ~51.3% (652 out of 1,271) of the patients had pN1 disease. In multivariate logistic regression analyses, gender, tumor size and location, multifocality, age, and Delphian lymph node status were all independent predictors of CLNM. In predicting CLNM, six ML algorithms posted AUROC of 0.70–0.75, with the extreme gradient boosting (XGBoost) model standing out, registering 0.75. Thus, we employed the best-performing ML algorithm model and uploaded the results to a self-made online risk calculator to estimate an individual's probability of CLNM (https://jin63.shinyapps.io/ML_CLNM/).Conclusions: With the incorporation of preoperative and intraoperative risk factors, ML algorithms can achieve acceptable prediction of CLNM with Xgboost model performing the best. Our online risk calculator based on ML algorithm may help determine the optimal extent of initial surgical treatment for patients with T1-T2 stage, non-invasive, and clinically node negative PTC.

Central neck lymph node metastasis in oral squamous cell carcinoma at the floor of mouth

sBackgroundOur goal was to analyze the incidence of level VI metastasis in previously untreated oral squamous cell carcinoma (SCC) patients and their clinicopathological and prognostic characteristics.MethodsOral SCC patients with level VI metastasis were retrospectively enrolled, and their demographic and pathologic features as well as their survival data were descriptively analyzed.ResultsA total of 13 cases from 1875 patients were included, all patients had SCC at the floor of mouth (SCCFOM). Eight (61.5%) patients had a pT4 tumor, and all patients had a pathological N3 neck with multiple positive lymph nodes. Adverse pathologic features were present in 100% of the patients. The size of the metastatic foci in level VI ranged from 2.6 cm to 4.5 cm with a mean value of 3.2 cm, and 5 patients showed a soft tissue deposit with no lymph node component. Recurrence occurred in all patients, and 11 patients died of uncontrolled cancer within 5 years after surgery.ConclusionLevel VI metastasis in primary oral SCCFOM is rare, and its prognosis is poor.

Prognostic Assessment of BRAF Mutation in Preoperative Thyroid Fine-Needle Aspiration Specimens

We investigate the potential role of BRAF testing in guiding surgical intervention in papillary thyroid carcinoma (PTC). Thyroid fine-needle aspiration (FNA) cases with available BRAF result and follow-up thyroidectomy for PTC were included in the study. Cytology and surgical diagnoses were correlated with BRAF status. There were 151 cases of thyroid FNA specimens with BRAF testing (70 mutant and 81 wild-type BRAF) and histologically confirmed unilateral, unifocal PTCs. There were no differences in age, sex, tumor size, or lymphovascular invasion on thyroidectomy specimens between mutant and wild-type BRAF cases. BRAF mutation was significantly associated with cytology diagnosis (P < .001), PTC subtype (P < .001), extrathyroidal extension (ETE) (P = .006), and higher tumor (T) stage (P = .04). However, an analysis within the histologic subtypes of PTC revealed no significant association between BRAF mutation and ETE or higher T stage. There was also no difference in central (P = .847) or lateral (p = 1) neck lymph node (LN) metastasis. BRAF mutation identified in thyroid FNA specimens correlates with histologic subtypes but is not an independent factor for predicting PTC biological behavior and should not be used to guide the extent of LN dissection.

Transoral robotic thyroidectomy versus transoral endoscopic thyroidectomy: a propensity-score-matched analysis of surgical outcomes.

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) has been shown to be safe and has similar outcomes as open thyroidectomy for selected patients. It is not clear if transoral robotic thyroidectomy (TORT) may extend transoral endoscopic thyroidectomy to more complex thyroid operations. The study aimed to compare the safety and outcomes of TORT with those of TOETVA. We retrospectively reviewed all patients who had TORT and TOETVA performed by a single surgeon from June 2017 to May 2019. Intrathoracic goiter and combined operations were excluded. Surgical outcomes were compared after propensity score matching. Learning curves, as measured by operating time, were evaluated. A total of 150 patients underwent 154 transoral (55 TORT and 99 TOETVA) thyroidectomy. Of the 154 operations, 28 (18.2%) were bilateral total thyroidectomy and 126 (81.8%) were unilateral thyroid lobectomy. After propensity score matching, we found a longer operative time (median [interquartile range]) for TORT (n = 53) than for the TOETVA (308 [284-388] vs 228 [201-267] min, P < 0.001). Blood loss and visual analog scale scores for pain were not significantly different between the two groups. Central neck lymph node dissection was performed more frequent in the TORT group (28 of 53 [52.8%] vs 10 of 53 [18.9%], P = 0.001), and when performed, the numbers of total and positive lymph nodes did not differ significantly between the two groups. The rates of hypoparathyroidism and recurrent laryngeal nerve injury did not differ significantly between the two groups. There was no conversion to open thyroidectomy, mental nerve injury, or surgical site infection. The learning curve for TORT was 25 cases, but no obvious learning curve was observed for TOETVA. TORT requires a longer operative time, but is as safe as TOETVA and may be useful for more complex thyroid operations.