The online version of this article (doi:10.1186/1477-7819-10-226) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
JHK, the corresponding author of this study, provided the major idea, planed and approved the written work, performed the operations. WWK contributed literature review and writing the manuscript and analyzing clinicopathologic data. SIY contributed literature review and drafted the manuscript. YSC, YHP and SKK gave advices about clinical variables to analyze and edited the discussion. All authors read and approved the manuscript.
Recently, lymph node metastasis (LNM) has been regarded as an important factor influencing loco-regional recurrence and survival rate in papillary thyroid cancer (PTC) patients. The aims of this study were to investigate the detection rate and metastasis rate of the Delphian lymph node (DLN) and clinical patterns related to regional LNM, and to examine how DLN metastasis affects PTC treatment.
We reviewed the medical records of 413 patients with pathologically confirmed PTC from among 452 patients who underwent thyroid surgery between January 2010 and October 2010 in the Department of Endocrine Surgery at Kosin University Gospel Hospital in Busan, South Korea.
Multivariate analyses revealed a significantly higher proportion of cases with lymphovascular invasion (56.6% vs. 12.5%, P <0.001), central neck node metastasis (88.6% vs. 34.5%, P <0.001) and lateral neck node metastasis (47.2% vs. 10.2%, P <0.005) among cases with DLN metastasis compared to those without. The negative predictive value (NPV) of DLN metastasis with regard to the presence of contralateral central LNM for cases with a tumor size 1 cm or smaller than 1 cm was found to be 93.3% (127/136).
When DLN metastasis is not detected in papillary thyroid microcarcinomas (PTMC), thyroid lobectomy on the affected side and ipsilateral central neck lymph node dissection should be sufficient. In addition, even in cases where lateral neck LNM is not detected on preoperative examination, if DLN metastasis is detected postoperatively, more careful attention should be paid to the lateral neck nodes during follow-up.
Authors’ original file for figure 112957_2012_1172_MOESM1_ESM.docx
Ito Y, Tomoda C, Uruno T, Takamura Y, Miya A, Kobayashi K, Matsuzuka F, Kuma K, Miyauchi A: Preoperative ultrasonographic examination for lymph node metastasis: usefulness when designing lymph node dissection for papillary microcarcinoma of the thyroid. World J Surg. 2004, 28: 498-501. 10.1007/s00268-004-7192-z. CrossRefPubMed
Gawlak-Prycka A: [Prelaryngeal lymph node (Delphian) in patients with laryngeal cancer]. Otolaryngol Pol. 2001, 55: 35-41. PubMed
Nam IC, Park JO, Joo YH, Cho KJ, Kim MS: Pattern and predictive factors of regional lymph node metastasis in papillary thyroid carcinoma: a prospective study. Head Neck. 2012, 10.1002/hed.22903. Article first published online: 20 JAN 2012
Son YI, Jeong HS, Baek CH, Chung MK, Ryu J, Chung JH, So YK, Jang JY, Choi J: Extent of prophylactic lymph node dissection in the central neck area of the patients with papillary thyroid carcinoma: comparison of limited versus comprehensive lymph node dissection in a 2-year safety study. Ann Surg Oncol. 2008, 15: 2020-2026. 10.1245/s10434-008-9928-8. CrossRefPubMed
Mercante G, Frasoldati A, Pedroni C, Formisano D, Renna L, Piana S, Gardini G, Valcavi R, Barbieri V: Prognostic factors affecting neck lymph node recurrence and distant metastasis in papillary microcarcinoma of the thyroid: results of a study in 445 patients. Thyroid. 2009, 19: 707-716. 10.1089/thy.2008.0270. CrossRefPubMed
- Experience and analysis of Delphian lymph node metastasis in patients with papillary thyroid carcinoma
Won Woong Kim
Song I. Yang
Jeong Hoon Kim
Young Sik Choi
Su Kyoung Kwon
- BioMed Central
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