The Significance of Delphian Lymph Node in Papillary Thyroid Cancer

Hong, Sung Chul; Park, Seung Yeon; Lee, Young Don

Abstract

PURPOSE
The Delphian lymph node (DLN) has long beenregarded as a predictor of thyroid malignancy and indicator of advanced disease; however, there are a few published data in relation to the thyroid. Therefore we are to determine the significance of DLN involvement in differentiated papillary carcinoma.
METHODS
We prospectively assessed the discovering rate of DLN and the frequency of DLN metastasis in the consecutive patients undergoing total thyroidectomy with central neck node dissection at Endocrine Surgery Department of our hospital. And we assessed whether DLN involvement may predict extensive cervical lymph node disease and other unfavorable prognostic factors.
RESULTS
The DLN was separately removed and identified as such in 42 of 164 patients (25.6%), and 9 of 42 patients (21.4%) had DLN metastases. DLN involvement was not associated with larger tumor size (1.8 vs. 1.1 cm), age (41 vs. 46 years), perithyroidal tissue invasion (66.6 vs. 72.7%) and lymphovascular invasion. DLN involvement was highly predictive of central compartment metastasis (sensitivity 100%, specificity 41%), high proportion of metastatic nodes, and moderately suggestive of further disease in the lateral compartment (sensitivity 44%, specificity 92%).
CONCLUSION
Although the clinical appearance of the DLN is not an accurate indicator of the presence of thyroid cancer, metastatic involvement of the DLN is an adverse prognostic marker in papillary thyroid cancer. The presence of DLN metastasis in patients with thyroid cancer should alert the surgeon to the high probability of advanced disease and need for paying greater attention to the central and lateral compartment lymph nodes.