Open Access, Peer-reviewed
pISSN 2288-6575
eISSN 2288-6796
    J Korean Surg Soc. 2010 Feb;78(2):82-86. Korean.
    Published online Feb 19, 2010.
    https://doi.org/10.4174/jkss.2010.78.2.82
    Copyright © 2010 The Korean Surgical Society
    Original Article

    Risk Factors of Lymph Node Metastasis in Papillary Thyroid Microcarcinoma

    Nam Seop Lee, M.D., Ja Seong Bae, M.D., So-Ryeong Jeong, M.D.,1 Chan Kwon Jung, M.D.,2 Dong Jun Lim, M.D.,3 Woo Chan Park, M.D., Jeong Soo Kim, M.D. and Seung Nam Kim, M.D.
      • Department of Surgery, The Catholic University College of Medicine, Seoul, Korea.
      • 1Department of Radiology, The Catholic University College of Medicine, Seoul, Korea.
      • 2Department of Pathology, The Catholic University College of Medicine, Seoul, Korea.
      • 3Department of Internal Medicine, The Catholic University College of Medicine, Seoul, Korea.
    • Corresponding author (Email: drbae@catholic.ac.kr )
    Received October 06, 2009; Accepted November 23, 2009.

    Abstract

    Purpose

    Despite the overall excellent prognosis for patients with papillary thyroid microcarcinoma (PTMC), these tumors are also associated with a 5% relatively high lymph node (LN) recurrence rate and the optimal surgical extent of papillary thyroid microcarcinoma has been controversial. Cervical LN metastases (LNMs) are found in about 40~65% of patients with PTMC. The aim of this study is to identify the factors affecting lymph node metastases (LNMs) in patients with PTMC.

    Methods

    We performed a retrospective study of 335 patients with PTMC who underwent total thyroidectomy or lobectomy with elective central lymph node dissection (CLND) at Kangnam St. Mary's Hospital between Jan. 2006 and Dec. 2008. We investigated the association of LNMs and clinicopathologic factors such as sex, age, multiplicity, extrathyroidal extension, and tumor size.

    Results

    LNMs were present in 88 patients (26.3%). Univariate analysis showed that less than 45 years of age, male, multiplicity, a tumor size of greater than 5 mm, thyroid capsular invasion and extrathyroidal extension were predictive factors for LNMs (P<0.05). Of these, the age, male, tumor size and extrathyroidal extension were independent predictive factors for LNMs on multivariate analysis.

    Conclusion

    A tumor size (>5 mm), male, age (<45) and extrathyroidal extension were determined as the predictive factors for LNMs, which occurred in about one fourth of the patients with PTMC. Therefore, elective CLND should be considered in patients with PTMC who have these factors through a thorough investigation before surgery.

    Keywords
    Papillary thyroid microcarcinoma; Central lymph node metastasis

    Tables

    Table 1
    Demographics of patients with papillary microcarcinoma

    Table 2
    Univariate and multivariate analysis of association between clinicopathologic features and central lymph node metastasis in patients with papillary microcarcinoma

    References

      1. Yokozawa T, Miyauchi A, Kuma K, Sugawara M. Accurate and simple method of diagnosing thyroid nodules the modified technique of ultrasound-guided fine needle aspiration biopsy. Thyroid 1995;5:141–145.
      1. Hedinger C, Williams ED, Sobin LH. The WHO histological classification of thyroid tumors: a commentary on the second edition. Cancer 1989;63:908–911.
      1. Yoo YS, Kim SS, Mun SP, Kim KJ, Chang JH, Min YD, et al. Clinicopathologic findings of micropapillary carcinomas, according to tumor size. J Korean Surg Soc 2009;76:348–354.
      1. Kim JH, Yang JH. Papillary microcarcinoma of the thyroid. J Korean Surg Soc 2001;61:485–490.
      1. Lee KJ, Kim HR, Kim SJ, Lee SC, Kim JG, Sung GY, et al. Analysis of the relationship between central cervical lymph node metastasis from papillary thyroid carcinoma and the associated factors according to the tumor size. J Korean Surg Soc 2008;75:156–161.
      1. 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;30:91–99.
      1. Chow SM, Law SC, Chan JK, Au SK, Yau S, Lau WH. Papillary microcarcinoma of the thyroid-Prognostic significance of lymph node metastasis and multifocality. Cancer 2003;98:31–40.
      1. 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;237:399–407.
      1. Shindo M, Wu JC, Park EE, Tanzella F. The importance of central compartment elective lymph node excision in the staging and treatment of papillary thyroid cancer. Arch Otolaryngol Head Neck Surg 2006;132:650–654.
      1. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1167–1214.
      1. Yamamoto Y, Maeda T, Izumi K, Otsuka H. Occult papillary carcinoma of the thyroid. A study of 408 autopsy cases. Cancer 1990;65:1173–1179.
      1. Harach HR, Franssila KO, Wasenius VM. Occult papillary carcinoma of the thyroid. A "normal" finding in Finland. A systematic autopsy study. Cancer 1985;56:531–538.
      1. Shaha AR, Tuttle RM, Shah JP. Papillary microcarcinoma of the thyroid. J Surg Oncol 2007;95:532–533.
      1. Appetecchia M, Scarcello G, Pucci E, Procaccini A. Outcome after treatment of papillary thyroid microcarcinoma. J Exp Clin Cancer Res 2002;21:159–164.
      1. Sakorafas GH, Giotakis J, Stafyla V. Papillary thyroid microcarcinoma: a surgical perspective. Cancer Treat Rev 2005;31:423–438.
      1. Hay ID, Grant CS, van Heerden JA, Goellner JR, Ebersold JR, Bergstralh EJ. Papillary thyroid microcarcinoma: a study of 535 cases observed in a 50-year period. Surgery 1992;112:1139–1146.
        discussion 46-7.
      1. Harwood J, Clark OH, Dunphy JE. Significance of lymph node metastasis in differentiated thyroid cancer. Am J Surg 1978;136:107–112.
      1. Ozaki O, Ito K, Kobayashi K, Suzuki A, Manabe Y. Modified neck dissection for patients with nonadvanced, differentiated carcinoma of the thyroid. World J Surg 1988;12:825–829.
      1. Sampson RJ, Oka H, Key CR, Buncher CR, Iijima S. Metastases from occult thyroid carcinoma. An autopsy study from Hiroshima and Nagasaki, Japan. Cancer 1970;25:803–811.
      1. Kasai N, Sakamoto A. New subgrouping of small thyroid carcinomas. Cancer 1987;60:1767–1770.
      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;15:2482–2486.
      1. Besic N, Zgajnar J, Hocevar M, Petric R. Extent of thyroidectomy and lymphadenectomy in 254 patients with papillary thyroid microcarcinoma: a single-institution experience. Ann Surg Oncol 2009;16:920–928.
      1. Cady B, Sedgwick CE, Meissner WA, Wool MS, Salzman FA, Werber J. Risk factor analysis in differentiated thyroid cancer. Cancer 1979;43:810–820.
      1. Scheumann GF, Gimm O, Wegener G, Hundeshagen H, Dralle H. Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer. World J Surg 1994;18:559–567.
      1. Gulben K, Berberoglu U, Celen O, Mersin HH. Incidental papillary microcarcinoma of the thyroid--factors affecting lymph node metastasis. Langenbecks Arch Surg 2008;393:25–29.
      1. Lee SH, Lee SS, Jin SM, Kim JH, Rho YS. Predictive factors for central compartment lymph node metastasis in thyroid papillary microcarcinoma. Laryngoscope 2008;118:659–662.
      1. Sugg SL, Ezzat S, Rosen IB, Freeman JL, Asa SL. Distinct multiple RET/PTC gene rearrangements in multifocal papillary thyroid neoplasia. J Clin Endocrinol Metab 1998;83:4116–4122.
    Cited by
    Crossref 12
    Google Scholar 
    MeSH Terms
    Carcinoma, Papillary
    Humans
    Lymph Node Excision
    Lymph Nodes
    Male
    Neoplasm Metastasis
    Prognosis
    Recurrence
    Retrospective Studies
    Risk Factors
    Thyroid Gland
    Thyroid Neoplasms
    Thyroidectomy
    Metrics
    Share
    Tables
    slide
    slide

    1 / 2

    PERMALINK