Elsevier

Surgery

Volume 157, Issue 1, January 2015, Pages 111-118
Surgery

Endocrine
Central lymph node metastasis in papillary thyroid microcarcinoma can be stratified according to the number, the size of metastatic foci, and the presence of desmoplasia

https://doi.org/10.1016/j.surg.2014.05.023Get rights and content

Background

Lymph node (LN) metastasis is common in papillary thyroid microcarcinoma (PTMC). The aim of this study was to investigate the impact of LN metastasis and its risk stratification on PTMC recurrence.

Methods

We retrospectively reviewed the data of 336 patients with PTMC who underwent surgery from 2005 to 2006 at a single institution. LN metastasis was stratified according to the number of metastatic LNs, the ratio of metastatic to removed LNs, the size of metastatic foci in LNs, and the presence of extranodal extension and desmoplasia.

Results

Of the 336 patients, 93 (28%) had LN metastasis. During the follow-up of 5.3 years, 16 (4.8%) experienced locoregional recurrence. Among several clinicopathologic factors, LN metastasis was the most important risk factor for recurrence (P = .02). Lateral LN metastasis was correlated with recurrence-free survival (P < .01), whereas central LN metastasis was not (P = .20). When central LN metastasis was stratified, a high number of metastatic LNs (≥3), larger metastatic foci (≥0.2 cm), and the presence of desmoplasia were associated with recurrence-free survival (P < .05).

Conclusion

The prognostic significance of central LN metastasis can differ according to the number of metastatic LNs, the size of metastatic foci, and the presence of desmoplasia. Patients with a high number of metastatic LNs, larger metastatic foci, and presence of desmoplasia in LNs should be treated aggressively and supervised carefully for PTMC recurrence.

Section snippets

Materials and methods

This study included patients who underwent surgery at the Korea Cancer Center Hospital, Seoul, Korea, from January 2005 to December 2006 and had PTC of 1.0 cm or smaller on operative specimens. Patients whose age at diagnosis was <20 years were excluded from the study. During the period, 724 patients with PTC underwent operation at our hospital. Among them, 404 (56%) patients had PTMC on final operative pathologic analysis. Of these, 68 patients who did not undergo central LN dissection were

Results

A total of 336 patients were analyzed, and the basic characteristics of these patients are summarized in Table I. The mean age of patients was 48 years (range, 22–73 years), and there were 29 men and 307 women. Approximately half (54%) of the patients underwent TT and radioactive iodine ablation. The other patients (45%) underwent unilateral lobectomy, except 2 who had subtotal thyroidectomy. All patients underwent central neck dissection, and 29 patients had modified radical neck dissection.

Discussion

Our results indicate that central LN metastases in PTMC are interpreted differently depending on the number of metastatic LNs, the size of metastatic foci, and the presence of desmoplasia. In this study, of 336 patients with PTMC, 16 (4.8%) experienced recurrence during the follow-up period of 5.3 years. Among several clinicopathologic factors, LN metastasis was the most potent risk factor for recurrence. However, central LN metastasis did not affect the recurrence whereas lateral LN metastasis

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