Incidence Of Central Lymph Node Metastasis Research Articles

Risk factors of cervical lymph node metastasis in multifocal papillary thyroid cancer.

Identifying risk variables for cervical lymph node metastases in multifocality papillary thyroid cancer (MPTC) could assist surgeons in determining whether cervical lymph node dissection would be an appropriate surgical option. A retrospective cohort of 2006 patients with papillary thyroid cancer were selected. MPTC (N = 460) was defined as the presence of two or more foci of PTC. The risk factors for central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM) in MPTC were investigated by univariate and multivariate analyses, including the following items: age at diagnosis, gender, Hashimoto's thyroiditis, extrathyroidal extension (ETE), maximal axial diameter (MAD) and the sum of axial diameters (SAD) of tumor. In addition, CLNM was used to evaluate LLNM. The incidence of CLNM and LLNM was 44.57% and 17.17%, respectively. The multivariate analysis demonstrated that gender, extrathyroidal extension (ETE), age, maximal axial diameter (MAD), and the sum of axial diameters (SAD) were related to increased risk for CLNM in MPTC (p < 0.05). The area under the receiver operating characteristic (ROC) curve (AUC) for age at diagnosis of CLNM was 0.647, the cut-off value was 50 years old. Additionally, by multivariate analysis, CLNM, ETE, MAD, and SAD were independent risk factors for LLNM in MPTC (p < 0.05). ROC curve analysis demonstrates that AUC for MAD and SAD diagnosis of LLNM were 0.639 and 0.757, and the cut-off values were 16 and 26mm, respectively. MPTC patients who have risk factors for CLNM were advised to perform prophylactic central lymph node dissection (CLND). Additionally, the presence of risk factors for LLNM should be individually evaluated and analyzed for the necessity of lateral lymph node dissection.

Effects of Patient and Tumor Characteristics on Central Lymph Node Metastasis in Papillary Thyroid Cancer: A Guide for Selective Node Dissection.

Prophylactic central lymph node dissection (CLND) in papillary thyroid carcinoma (PTC) is still controversial. This study aimed to analyze the factors related to the patient and tumor characteristics affecting central lymph node metastasis (CLNM) in PTC patients and to evaluate the contribution of the results to shaping the surgical treatment algorithm. Two hundred and fifty-five PTC patients who underwent total thyroidectomy and CLND were evaluated retrospectively. Histopathology reports were examined to reveal tumor characteristics. The CLNM ratio and the relationship between CLNM with clinicopathological and demographic characteristics were analyzed. The incidence of CLNM was 54.9% (95 CI%: 49-60.8). Male gender (P=0.027), age<45 years (P=0.016), tumor size≥9.5 mm (P<0.001), lymphovascular invasion (P<0001) and extracapsular invasion (P=0.007) were factors that increased the risk of metastasis. The follicular variant decreased the risk (P=0.010). There was no relationship between CLNM and focality (P=0.054). A low-to-moderate correlation was found between tumor diameter and the metastatic lymph node (MLN) number/total lymph node number ratio (r=0.396, P<0.001). A selective prophylactic CLND strategy can be applied in cN0 patients. As the tumor diameter increases in PTC, both the risk of CLNM and the number of MLN increase. Lymphovascular and extracapsular invasion are other factors that increase the risk. The follicular variant is associated with a lower risk of CLNM. Male patients who are under the age of 45 and have a tumor diameter of 9.5 mm or more are definite candidates for prophylactic CLND.

Predicting factors of central lymph node metastasis and BRAFV600E mutation in Chinese population with papillary thyroid carcinoma

ObjectiveThe aim of this study was to evaluate the predictive factors of central lymph node metastasis (CLNM) and BRAFV600E mutation in Chinese patients with papillary thyroid carcinoma (PTC).MethodsA total of 943 PTC patients who underwent thyroidectomy from 2014 to 2016 at our hospital were enrolled. Those patients were divided into PTC > 10 mm and papillary thyroid microcarcinoma (PTMC) groups by tumor size. The BRAFV600E mutation was examined by quantitative real-time PCR. Univariate and multivariate analyses were used to examine risk factors associated with CLNM and the BRAFV600E mutation.ResultsThe frequency of CLNM was 53% (505/943). Both univariate and multivariate analyses suggested that the risk factors for CLNM in PTC patients were male, younger age, and larger tumor size (P < 0.05). Coexistent Hashimoto thyroiditis (HT) was an independent protective factor against CLNM when the tumor was > 10 mm (P = 0.006). Stratified analysis revealed that male, age ≤ 30 years, and tumor size > 5 mm were independent risk factors for CLNM. The BRAFV600E mutation rate was 85%. Multivariate logistic regression analysis revealed that age (P < 0.001) and coexistent HT (P = 0.005) were independent predictive factors of BRAFV600E mutation in PTC patients. Only age was a risk factor for the BRAFV600E mutation when the tumor was > 10 mm (P = 0.004). In the PTMC group, the BRAFV600E mutation was significantly correlated with tumor size (P < 0.001) and coexistent HT (P = 0.03). Stratified analysis revealed that age > 30 years and tumor size > 5 mm were independent predictive factors of BRAFV600E mutation. Furthermore, the incidence of CLNM was significantly higher in BRAFV600E mutation-positive patients (P = 0.009) when the tumor was ≤ 5 mm.ConclusionThe factors male, younger age (≤ 30 years), large tumor size (> 5 mm), and coexistent HT are independent predicative factors for CLNM. The BRAFV600E mutation is associated with both large size and without HT in PTMC patients, age > 30 years in the PTC > 10 mm group. The BRAFV600E mutation was an independent risk factor for CLNM when the tumor was ≤ 5 mm. For optimal management, these features should be comprehensively evaluated to determine the initial surgical approach for PTC patients.

Risk Factors of Central Lymph Node Metastasis in Papillary Thyroid Microcarcinoma and the Value of Sentinel Lymph Node Biopsy.

Objective: The present study aims to investigate the risk factors of central lymph node metastasis (CNM) in papillary thyroid microcarcinoma (PTMC) and evaluate the predictive value of sentinel lymph node biopsy (SLNB) during surgery.Methods: The clinicopathological data of 179 patients with PTMC staging in cN0 and with SLNB performed were analyzed retrospectively. Positive sentinel lymph node ratio (PSLNR) and additional positive lymph node (APLN) were analyzed in cases with positive SLNB. The efficiency of SLNB was investigated. ROC curves were plotted to evaluate the predictive value of PSLNR for APLN.Results: Cumulative maximum diameter of tumors (CMD) (P = 0.041) and capsule involvement (CI) (P = 0.014) were independent risk factors for central lymph node metastasis. The SLNB success rate was 97.28%, and the incidence of CNM was 31.28%. The sensitivity, specificity, false positive rate (FPR), false negative rate (FNR), positive predictive value (PPV), and negative predictive value (NPV) of SLNB to evaluate CNM and APLN were 82.14 vs. 61.54%, 100 vs. 80.39%, 0 vs. 19.61%, 17.86 vs. 38.46%, 100 vs. 34.78%, and 92.48 vs. 92.48%, respectively. For cases with positive SLNB, subgroup analysis was performed according to APLN. The PSLNRs of true and false positive groups were 0.4620 ± 0.1744 and 0.2425 ± 0.1355, respectively (P < 0.001). Analyzing the predictive value of PSLNR by the ROC curve, the optimal diagnostic cutoff point was 0.2917 [AUC = 0.861 (95% CI: 0.757, 0.966), P < 0.001], and the sensitivity, specificity, FPR, FNR, PPV, and NPV of PSLNR were 87.50, 73.33, 26.67, 12.50, 63.64, and 91.67%, respectively.Conclusion: CMD and CI are independent risk factors for central lymph node metastasis in PTMC. SLNB has good predictive value for CNM. For cases with positive SLNB, PSLNR could be used to predict the presence of APLN, which may provide a theoretical basis for intraoperative lymph node dissection.

Predictive value of the Delphian lymph node in cervical lymph node metastasis of papillary thyroid carcinoma

IntroductionDelphian lymph node metastasis (DLNM) has proven to be a risk factor for a poor prognosis in head and neck malignancies. This study aimed to reveal the clinical features and evaluate the predictive value of the Delphian lymph node (DLN) in papillary thyroid carcinoma (PTC) to guide the extent of surgery. MethodsTianjin Medical University Cancer Institute and Hospital pathology database was reviewed from 2017 to 2020, and 516 PTC patients with DLN detection were enrolled. Retrospective analysis was performed, while multivariate analysis was performed to identify the risk factors for DLNM. ResultsAmong the 516 PTC patients with DLN detection, the DLN metastasis rate was 25.39% (131/516). Tumor size >1 cm, location in the upper 1/3, central lymph node metastasis (CLNM), lateral lymph node metastasis (LLNM) and lymphovascular invasion were independent risk factors for DLNM. Patients with DLNM had a higher incidence of ipsilateral CLNM, contralateral CLNM (CCLNM) and LLNM, and larger numbers and size of metastatic CLNs than those without DLNM. The incidence of CLNM among cN0 patients with DLNM was higher than that among those without DLNM. The incidence of CCLNM among unilateral cN + patients with DLNM was similarly higher than that among patients without DLNM. ConclusionsDLNM indicates a high likelihood and large number of cervical lymph nodes metastases in PTC patients. Surgeons are strongly recommended to detect DLN status during operation by means of frozen pathology, so as to evaluate the possibility of cervical nodal metastasis and decide the appropriate extent of surgery.

Predicting the factors associated with central lymph node metastasis in clinical node-negative (cN0) papillary thyroid microcarcinoma.

The aim of the present study was to investigate the risk factors associated with central lymph node metastasis (CLNM) in papillary thyroid microcarcinoma (PTMC). A total of 553 patients with PTMC confirmed by histological examination, who underwent thyroidectomy and central neck dissection (CND), were enrolled. The clinicopathological and ultrasonographic features from the patients were analyzed retrospectively. PTMC patient age, Hashimoto thyroiditis (HT), tumor location, extrathyroidal extension (ETE), microcalcification and higher E values were correlated with the incidence of CLNM. Multivariate logistic regression analysis showed that age, HT, tumor location, ETE and Emax were related to the extent of CLNM. Chi-squared automatic interaction detection (CHAID) classification tree model showed that patients with tumor in upper/lower third combined ETE had a high risk of CLNM. Furthermore, cN0 PTMC patients with age ≤ 45years and ETE had more extensive CLNM. Our observations could be helpful for the assessment of prognostic factors of PTMC patients with CLNM.

The Clinicopathological Features of Papillary Thyroid Carcinoma Patients with Positive Hepatitis B Surface Antigen

Background: Hepatitis B virus infection has been reported to be associated with some kinds of cancer. The aim of this study was to investigate clinicopathological features of papillary thyroid carcinoma (PTC) patients with positive hepatitis B surface antigen (HBsAg). Materials and Methods: A total of 569 PTC patients were analyzed retrospectively in this study. The relationships of HBsAg with clinicopathologic features of PTC were analyzed by univariate analysis. The relationships of central lymph node metastasis (CLNM) with clinicopathological features of PTC were analyzed by univariate and multivariate logistic regression analysis. Results: The incidence of CLNM in PTC with positive HBsAg was higher than that in PTC with negative HBsAg (71.4 vs. 60.0%, p = 0.047). Univariate analysis showed that positive HBsAg was significantly associated with bilateral tumors (p = 0.043) and lymph node metastasis (LNM) (p = 0.047) in PTC patients. In addition, the incidence of CLNM in patients with PTC was 61.7% (351 of 569 cases). Univariate analysis showed that CLNM of patients with PTC was significantly associated with positive HBsAg (p = 0.047). Multivariate logistic regression analysis revealed that positive HBsAg (p = 0.038) was an independent predictor of CLNM in patients with PTC. Conclusions: The incidence of CLNM in PTC patients with positive HBsAg was significantly higher than that of patients with negative HBsAg. Positive HBsAg was correlated with LNM and bilateral tumors. In addition to gender, age <45 years, tumor size >2 cm, and lateral LNM, positive HBsAg was also an independent predictor of CLNM in PTC patients.

Identification of risk factors of central lymph node metastasis and evaluation of the effect of prophylactic central neck dissection on migration of staging and risk stratification in patients with clinically node-negative papillary thyroid microcarcinoma

The first aim of this study was to explore the risk factors that were associated with central lymph node metastasis (CLNM) in patients with clinically node-negative papillary thyroid microcarcinoma (cN0 PTMC) after prophylactic central neck dissection (PCND). The second aim was to evaluate the influence of PCND on migration of TNM staging and risk stratification (RS) in patients with cN0 PTMC. A total of 295 cN0 PTMC patients who underwent thyroidectomy with PCND in the Department of General Surgery at Guangdong General Hospital between March 2014 to December 2015 were assessed retrospectively. The relations of CLNM with clinicopathologic characteristics of cN0 PTMC were analyzed by univariate and multivariate logistic regression. The effect of PCND on migration of TNM staging and RS was also observed. The incidence of CLNM was 42.4% (125 of 295 cases) in patients with cN0 PTMC. Univariate analysis showed that age (P=0.000), ultrasonographic tumor size (P=0.009), pathologic tumor size (P=0.005), and multifocality (P=0.031) were significantly associated with the incidence of CLNM. No significant correlations were found between the presence of CLNM and other variables such as gender (P=0.399), bilaterality (P=0.118), capsular invasion (P=0.111), lymphovascular invasion (P=0.184), extent of thyroidectomy (P=0.319) and lymphadenectomy (P=0.458). Multivariate logistic regression analysis revealed that age <45 years (P=0.000) and multifocality (P=0.033) were independent predictors of CLNM in patients with cN0 PTMC. Because of the identification of CLNM in the implementation of PCND, 42 (14.2%) patients were upstaged, and 118 (40.0%) patients upgraded in RS. CLNM is highly prevalent in cN0 PTMC. Age <45 years and multifocality are independent risk factors of CLNM in cN0 PTMC patients. PCND can identify CLNM, which allows more accurate TNM staging/RS and may have an important impact on postoperative treatment in cN0 PTMC patients.