Multifocality and Total Tumor Diameter Predict Central Neck Lymph Node Metastases in Papillary Thyroid Microcarcinoma
- 13 September 2012
- journal article
- Published by Springer Science and Business Media LLC in Annals of Surgical Oncology
- Vol. 20 (3), 746-752
- https://doi.org/10.1245/s10434-012-2654-2
Abstract
To identify the subgroup of high-risk papillary thyroid microcarcinoma (PTMC) inclined to lymph node metastasis (LNM). Patients who underwent total thyroidectomy with central neck dissection and had a pathologic diagnosis of PTMC between 2003 and 2010 at Wuhan Union Hospital were identified. The frequency of LNM was retrospectively analyzed according to the clinicopathological features. For multifocal lesions, total tumor diameter (TTD) was calculated as the sum of the maximal diameter of each lesion. Last, a meta-analysis was performed with respect to multifocality and LNM in the PTMCs. The proportion of LNM was similar between multifocal PTMCs with TTD ≤ 1 cm and unifocal tumors with diameter ≤ 1 cm (37.5 vs. 30 %, P = 0.463). LNM frequency was also similar between multifocal PTMCs with 1 < TTD ≤ 2 cm (TTD greater than 1 cm but less than or equal to 2 cm) and unifocal tumors with 1 < diameter ≤ 2 cm (56.8 vs. 64.9 %, P = 0.330). However, LNM frequency was significantly higher in multifocal PTMCs with TTD > 1 cm than unifocal tumors with diameter ≤ 1 cm (60.4 vs. 30 %, P < 0.001). A meta-analysis of nine publications plus our own data with a total 1,586 PTMCs demonstrated that multifocality was significantly associated with LNM risk (odds ratio 1.9, 95 % confidence interval 1.5–2.4). Multifocal PTMC with TTD > 1 cm has a similar risk of LNM as a clinical papillary cancer. Routine central neck dissection is recommended in this subgroup of patients.Keywords
This publication has 33 references indexed in Scilit:
- Cervical lymphadenopathies signaling thyroid microcarcinoma. Case study and review of the literatureEuropean Annals of Otorhinolaryngology, Head and Neck Diseases, 2011
- Variables Predictive of Bilateral Occult Papillary Microcarcinoma Following Total ThyroidectomyOtolaryngology -- Head and Neck Surgery, 2010
- New clinical features of thyroid cancer in eastern ChinaJournal of Visceral Surgery, 2010
- Increasing incidence of differentiated thyroid cancer in the United States, 1988–2005Cancer, 2009
- Central lymph node metastases in unilateral papillary thyroid microcarcinomaBritish Journal of Surgery, 2009
- Predictive Factors for Central Compartment Lymph Node Metastasis in Thyroid Papillary MicrocarcinomaThe Laryngoscope, 2008
- Papillary thyroid microcarcinoma: Prognostic factors and treatmentJournal of Surgical Oncology, 2007
- Ultrasound Criteria of Malignancy for Cervical Lymph Nodes in Patients Followed Up for Differentiated Thyroid CancerJournal of Clinical Endocrinology & Metabolism, 2007
- Increasing Incidence of Thyroid Cancer in the United States, 1973-2002JAMA, 2006
- Thyroid papillary cancers: microcarcinoma and carcinoma, incidental cancers and non‐incidental cancers – are they different diseases?Clinical Endocrinology, 2005