J Korean Thyroid Assoc.  2013 Nov;6(2):121-125. 10.11106/jkta.2013.6.2.121.

Subclinical Central Lymph Node Metastasis in Papillary Thyroid Microcarcinoma Evaluated as cT1aN0 by Preoperative Imaging Study

• Kim ST
• Cheon BK
• Lee HS
• Kim SW
• Park HS
• Lee KD

• KMID: 1845384
• DOI: http://doi.org/10.11106/jkta.2013.6.2.121

Abstract

BACKGROUND AND OBJECTIVES
Papillary thyroid microcarcinoma (PTMC) generally has a highly favorable prognosis, however reports show a 30-65% prevalence of subclinical central lymph node metastasis. Therefore, the role of elective central neck dissection in PTMC treatment remains controversial. Our study focused on preoperative features of clinically lymph node negative and intracapsular (cT1aN0) PTMC and the correlation of these features with subclinical central lymph node metastasis.
MATERIALS AND METHODS
Of 584 PTC patients who underwent thyroidectomy at the Kosin University Gospel Hospital from January 2009 to July 2011, 219 patients with cT1aN0 PTMC were reviewed retrospectively. Pathologic results were reviewed and various clinicopathologic prognostic factors were investigated.
RESULTS
Postoperative pathology report revealed capsular invasion of primary tumor in 77 patients (35.2%) and subclinical central lymph node metastasis in 62 patients (28.3%). Tumor of the isthmic location was an independent predictor of subclinical central lymph node metastasis by multivariate analysis while multifocality showed borderline significance. The presence of extrathyroidal extension (ETE), multifocality, and cervical lymph node metastasis were significantly related to PTMC of isthmus. Seven of the 14 subjects with PTMC of the isthmus (50%) had pretracheal lymph node metastasis showing significant correlation (p=0.001).
CONCLUSION
Despite the absence of ETE and lymph node metastasis in the preoperative imaging studies, higher risk of subclinical central lymph node metastasis should be considered in PTMC with multifocality and tumor of the isthmus.

Keyword

Papillary thyroid microcarcinoma; Neck dissection

MeSH Terms

Carcinoma, Papillary
Humans
Lymph Nodes*
Multivariate Analysis
Neck Dissection
Neoplasm Metastasis*
Pathology
Prevalence
Prognosis
Retrospective Studies
Thyroid Gland*
Thyroid Neoplasms
Thyroidectomy

Reference

References

1. Roh JL, Kim JM, Park CI. Central cervical nodal metastasis from papillary thyroid microcarcinoma: pattern and factors predictive of nodal metastasis. Ann Surg Oncol. 2008; 15(9):2482–6.

2. Hyun SM, Song HY, Kim SY, Nam SY, Roh JL, Han MW, et al. Impact of combined prophylactic unilateral central neck dissection and hemithyroidectomy in patients with papillary thyroid microcarcinoma. Ann Surg Oncol. 2012; 19(2):591–6.

3. Wada N, Duh QY, Sugino K, Iwasaki H, Kameyama K, Mimura T, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg. 2003; 237(3):399–407.

4. Roh JL, Kim JM, Park CI. Lateral cervical lymph node metastases from papillary thyroid carcinoma: pattern of nodal metastases and optimal strategy for neck dissection. Ann Surg Oncol. 2008; 15(4):1177–82.

5. Giordano D, Gradoni P, Oretti G, Molina E, Ferri T. Treatment and prognostic factors of papillary thyroid microcarcinoma. Clin Otolaryngol. 2010; 35(2):118–24.

6. Kim YW, Wang SG, Lee JC, Lee BJ, Lee JW, Kim YK, et al. Clinically related factors and features of central compartment neck lymph nodes in thyroid micropapillary carcinoma. Korean J Otorhinolaryngol-Head Neck Surg. 2009; 52(3):232–6.

7. Zhang L, Wei WJ, Ji QH, Zhu YX, Wang ZY, Wang Y, et al. Risk factors for neck nodal metastasis in papillary thyroid microcarcinoma: a study of 1066 patients. J Clin Endocrinol Metab. 2012; 97(4):1250–7.

8. Choi SY, Kim JS, Soh EY, Park CH. Clinicopathologic characteristics of papillary carcinoma in the thyroid isthmus. J Korean Surg Soc. 2010; 78(2):77–81.

9. Harach HR, Franssila KO, Wasenius VM. Occult papillary carcinoma of the thyroid. A “normal” finding in Finland. A systematic autopsy study. Cancer. 1985; 56(3):531–8.

10. Ito Y, Uruno T, Nakano K, Takamura Y, Miya A, Kobayashi K, et al. An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid. 2003; 13(4):381–7.

11. Ito Y, Tomoda C, Uruno T, Takamura Y, Miya A, Kobayashi K, et al. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid. World J Surg. 2006; 30(1):91–9.

12. Choi SJ, Kim TY, Lee JC, Shong YK, Cho KJ, Ryu JS. et al. Is routine central neck dissection necessary for the treatment of papillary thyroid microcarcinoma? Clin Exp Otorhinolaryngol. 2008; 1(1):41–5.

13. Baudin E, Travagli JP, Ropers J, Mancusi F, Bruno-Bossio G, Caillou B, et al. Microcarcinoma of the thyroid gland: the Gustave-Roussy Institute experience. Cancer. 1998; 83(3):553–9.