ObjectiveTo evaluate the risk factors for central lymph node metastasis (CLNM) in papillary thyroid carcinoma (PTC) of cN0 staging. MethodsClinical data of 94 patients with cN0 PTC in Guangdong General Hospital who underwent thyroidectomy with prophylactic central node dissection (pCND) from March to July in 2014 were collected to analyze the risk factors of CLNM by using univariate and multivariate analysis methods. ResultsCLNM was found in 43 patients (45.7%). Multivariate analysis results showed that, the CLNM rate of patients with age < 45 years, tumor located in front of lobe by ultrasound, diameter of tumor > 2 cm, capsular invasion, and total number of central lymph node dissected > 3 were significantly higher (P < 0.05). ConclusionAge < 45 years, tumor located in front of lobe by ultrasound, and diameter of tumor > 2 cm are the risk factors of CLNM in patients with cN0 PTC, pCND should be performed for patients with some of the above risk factors.
Objective To investigate the value of sentinel lymph node biopsy (SLNB) in predicting the metastasis of central cervical lymph nodes (CCLN) in differentiated thyroid carcinoma, and to explore reasonable program for CCLN dissection. Methods This retrospective analysis was performed basing on the clinical data of 407 patients with differentiated thyroid carcinoma who were admitted to the Department of General Surgery of Xuanwu Hospital from June 2013 to December 2016, including 237 patients with microcarcinoma. Results ① The results of the lymph nodes detection. All patients had detected 7 766 lymph nodes (1 238 metastatic lymph nodes were detected from 219 patients), and 2 085 sentinel lymph nodes were detected (448 metastatic sentinel lymph nodes were detected from 189 patients). In the patients with microcarcinoma, there were 3 614 lymph nodes were detected (390 metastatic lymph nodes were detected from 97 patients), and 1 202 sentinel lymph nodes were detected (149 metastatic sentinel lymph nodes were detected from 82 patients). ② The value of SLNB to predict CCLN metastasis. The sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of SLNB to predict CCLN metastasis for all patients was 86.30% (189/219), 100% (188/188), 0 (0/189), 13.70% (30/219), 100% (189/189), and 86.24% (188/218) respectively; for patients with microcarcinoma was 84.54% (82/97), 100% (140/140), 0 (0/82), 15.46% (15/97), 100% (82/82), and 90.32% (140/155), respectively. ③ The value of SLNB to predict the presence of additional positive lymph nodes (APLN). The sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of SLNB to predict the APLN for all patients was 81.48% (132/162), 76.73% (188/245), 23.27% (57/245), 18.52% (30/162), 69.84% (132/189) and 86.24% (188/218), respectively; for patients with microcarcinoma was 73.68% (42/57), 77.78% (140/180), 22.22% (40/180), 26.32% (15/57), 51.22% (42/82) and 90.32% (140/155) respectively. ④ The value of positive sentinel lymph node ratio (PSLNR) to predict the presence of the APLN. The sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of PSLNR to predict the APLN for all patients was 71.97%, 78.95%, 21.05%, 28.03%, 88.79%, and 54.88% respectively, and the cutoff for PSLNR was 0.345 2. For patients with microcarcinoma, the sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of PSLNR to predict the APLN was 83.33%, 67.50%, 32.50%, 16.67%, 72.92%, and 79.41% respectively, and the cutoff for PSLNR was 0.291 7. Conclusion There is an important predicted value of SLNB for CCLN dissection in the patients suffered from differentiated thyroid carcinoma, and the PSLNR is a reliable basis for CCLN dissection.
Objective To explore the risk factors the central cervical lymph node micrometastasis of papillary thyroid microcarcinoma (PTMC). Methods PTMC patients who underwent surgical operations in West China Hospital, Sichuan University between January 2014 and December 2018 were retrospectively enrolled. The patient did not find lymph node metastasis in the central cervical area by preoperative ultrasound. During the operation, the central cervical lymph node of the affected side was dissected or lymph node dissection in the central area of the affected side of the neck plus the lateral area of the neck. With postoperative pathology as the gold standard, patients were divided into central cervical lymph node micrometastasis group (micrometastasis group) and central cervical lymph node non-metastasis group (non-metastasis group). The differences of clinical features and ultrasonic signs between the two groups were analyzed. Results A total of 507 patients were included, including 223 (44.0%) in the micrometastasis group and 284(56.0%) in the non-metastasis group. The results of univariate analysis showed that compared with the non-metastasis group, the patients in the micrometastasis group were younger, the tumor size were higher, the proportion of male, multifocality, bilateral involvement and thyroid capsular invasion were higher. The results of multiple logistic regression analysis showed that lower age [odds radio (OR)=0.967, 95% confidence interval (CI)(0.949, 0.985), P<0.001], male [OR=2.357, 95%CI (1.503, 3.694), P<0.001)], a larger maximum diameter of PTMC [OR=1.232, 95%CI (1.100, 1.379), P<0.001], a larger nodule volume of PTMC [OR=1.031, 95%CI (1.008, 1.114), P=0.032], multifocal lesion [OR=2.309, 95%CI (1.167, 4.570), P=0.016] and invasion of the thyroid capsule [OR=1.520, 95%CI (1.010, 2.286), P=0.045] were independent risk factors for central cervical lymph node micrometastasis. Conclusions The patient’s male, young age, PTMC nodule with large maximum diameter and large volume, multifocal, and invasion of the thyroid membrane are risk factors for the central cervical lymph node micrometastasis of PMTC patients. These clinical and ultrasound signs can provide a theoretical basis for doctors’ clinical management decisions.
ObjectiveTo investigate the value of central lymph node dissection in patients with cN0 papillary thyroid carcinoma. MethodThe clinical data of 128 patients with cN0 papillary thyroid carcinoma who had been performed central lymph node dissection during their hospitalization from December 2010 to July 2012 in Chinese PLA General Hospital were analyzed retrospectively. ResultsThe central neck lymph node metastasis rate was 35.94%(46/128) in 128 patients with cN0 papillary thyroid carcinoma, which in the patients with aged less than 45 years, with the tumor diameter larger than 1 cm, and with capsule or extrathyroidal invasion were significantly higher than those in the patients with aged larger than 45 years, with the tumor diameter less than 1 cm, and without capsule or extrathyroidal invasion (P < 0.05). After the operation, there were 22(17.19%) patients with temporary hypoparathyroidism as well as 3(2.34%) patients with temporary recurrent laryngeal nerve injury. However, no permanent recurrent laryngeal nerve injury and permanent hypoparathyroidism occurred. During the 14-32 months follow-up with an average 23.4 months, 2 cases of lateral neck lymph node metastases were observed. ConclusionAs an essential, effective, and safe operation to the patients with cN0 papillary thyroid carcinoma, central lymph node dissection should be performed by experienced hands.
ObjectiveTo systematically evaluate effectiveness and safety of total thyroidectomy(TT) plus prophylactic central neck dissection(PCND) versus TT for stage cN0 papillary thyroid carcinoma(PTC). MethodsDatabases including PubMed, EMbase, The Cochrane Library(Issue1, 2015), WanFang Data, CBM, and CNKI were searched to collect the randomized controlled trails(RCTs) and non-RCTs about TT+PCND versus TT for stage cN0 PTC. The retrieval time was from inception to March 2015. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality was evaluated independently by 2 reviewers. Then the meta-analysis was conducted using RevMan 5.1 software. ResultsA total of 10 non-RCTs involving 3 661 patients were included. There were 1 774 cases in the TT+PCND group and 1 887 cases in the TT group. The results of meta-analysis showed that: Related to postoperative complications, compared with TT group, the postoperative transient hypocalcemia rate〔OR=0.40, 95% CI(0.33, 0.49), P < 0.000 01〕and permanent hypocalcemia rate were higher〔OR=0.32, 95% CI(0.19, 0.55), P < 0.000 1〕, the recurrence rate was lower〔OR=1.51, 95% CI(1.07, 2.13), P=0.02〕in the TT+PCND group. But there were no differences in the transient laryngeal nerve palsy rate〔OR=0.73, 95% CI(0.49, 1.09), P=0.13〕and permanent laryngeal nerve palsy rate〔OR=0.87, 95% CI(0.50, 1.52), P=0.62〕between the 2 groups. ConclusionsTT+PCND is superior to TT in treating stage cN0 PTC for it's lower recurrence, but it is raising transient hypocalcemia and permanent hypocalcemia rate at the same time. And it is similar as TT in transient laryngeal nerve palsy and permanent laryngeal nerve palsy rate. So TT+PCND is safe and feasible for treating stage cN0 PTC when its indications are strictly controlled. However, for the quantity and quality limitation of the included studies, this conclusion still requires to be further proved by performing large scale and high quality RCTs. It suggests that doctors should choose a best therapy for stage cN0 PTC patients according to an integrative disease assessment.
ObjectiveTo investigate the risk factors affecting cervical central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM) in patients with papillary thyroid carcinoma (PTC). MethodsThe patients with newly diagnosed with PTC who underwent surgical treatment in this hospital from April 2020 to December 2023 were included. The univariate and multivariate logistic regression analyses were conducted to identify the risk factors affecting the occurrences of CLNM and LLNM in patients with PTC and a prediction model was developed using these risk factors. Additionally, the discriminatory power of the predictive model for CLNM or LLNM was evaluated using the area under the receiver operating characteristic curve (AUC). ResultsA total of 297 patients with PTC were included in this study, among whom 149 (50.2%) cases developed CLNM, and 41 (13.8%) cases developed LLNM. The multivariate analysis indicated that the male, age <36 years old, and maximum tumor diameter >5 mm were the independent risk factors for CLNM in the patients with PTC (P<0.05). The independent risk factors for LLNM in the patients with PTC were the age ≥59 years old, bilateral or isthmus distribution of cancer foci, maximum tumor diameter >5 mm, and invasion of capsule (P<0.05). The AUC (95%CI) of the CLNM prediction model, constructed using three risk factors (gender, age, and maximum tumor diameter), was 0.693 (0.633, 0.752). For the LLNM prediction model, which incorporated four factors [age, distribution of cancer foci, maximum tumor diameter, and capsular invasion], the AUC (95%CI) was 0.776 (0.707, 0.846). ConclusionsThe findings of this study suggest that younger male patients with PTC (age <36 years), and a maximum tumor diameter >5 mm have a higher risk of CLNM. However, the predictive model constructed for CLNM demonstrates only moderate discriminatory power. In contrast, elderly patients (age ≥59 years old) with PTC exhibiting a maximum tumor diameter >5 mm, capsular invasion, and bilateral (or isthmus) lesions are at greater risk of LLNM. The predictive model developed for LLNM shows a certain discriminatory performance.
ObjectiveTo establish a predictive model for neck lateral lymph node metastasis (LLNM) in unilateral papillary thyroid cancer (uni-PTC) with central lymph node metastasis (CLNM). MethodsThe uni-PTC patients with CLNM were included in this study. The patients underwent thyroid surgery in the 960th Hospital of the PLA Joint Logistics Support Force from May 2018 to December 2021, who were randomly divided into the modeling group and the validation group according to the ratio of 7∶3. The risk factors of neck LLNM were analyzed by univariate and multivariate logistic regression and the nomogram of prediction model was constructed. The receiver operating characteristic (ROC) curve and calibration curve were used to validate the prediction model. ResultsA total of 237 patients were included in this study, including 158 patients in the modeling group and 79 patients in the validation group. The LLNM occurred in the 84 patients of the modeling group and 43 patients of the validation group. The multivariate logistic regression analysis was performed according to the statistical indicators in the univariate analysis results of the modeling group and the risk factors considered in the previous studies. The results showed that the patients with maximum diameter of the lesions >1 cm, multiple lesions, extraglandular invasion, the rate of CLNM ≥0.414, and lesions located at the upper portion had higher probability of LLNM (OR>1, P<0.05). The area under ROC curve of the nomogram in predicting LLNM in the modeling group was 0.834 [95%CI (0.771, 0.896)], which in the validation group was 0.761 [95%CI (0.651, 0.871)]. The calibration curve showed a good calibration degree in the prediction model. ConclusionThe clinical risk prediction model established based on the risk factors can better predict the probability of LLNM.
ObjectiveTo investigate the effects of thyroid globulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb) statuses on central lymph node (CLN) metastasis in patients with differentiated thyroid cancer (DTC).MethodsA retrospective analysis was performed on 526 patients with DTC confirmed by pathology from nine participating institutions, who underwent the bilateral thyroidectomy plus bilateral CLN dissection. The clinicopathologic characteristics of different TGAb and TPOAb statuses of patients with DTC were compared, and whether the TGAb and TPOAb statuses were the independent risk factors of CLN metastasis in DTC patients or not was analyzed.ResultsAll of 526 patients with DTC were included in this study, 152 were males and 374 were females. The age was (44±11) years old. There were 63 cases of TgAb＋TPOAb＋, 60 cases of TgAb＋TPOAb－, 30 cases of TgAb－TPOAb＋, and 373 cases of TgAb－TPOAb－. It was found that there was a significant difference in the gender among the four different antibody statuses of patients, that was, women with abnormal antibodies were more common (P<0.001), not found that there were related to the tumor size, blood vessel invasion, nerve invasion, CLN metastasis, tumor multifocality, and bilateral tumor or not (P>0.050). In this study, there were 389 cases of CLN with metastasis and 137 cases of CLN without metastasis. The results of multivariate analysis found that the age and gender of the patients were the independent risk factors (P<0.001), but didn’t find the TgAb and TPOAb Statuses and other factors were related to the CLN metastasis (P>0.050).ConclusionsStatuses of TGAb and TPOAb aren’t obviously associated with CLN metastasis in patients with DTC, which is inconsistent with other studies. It needs to be further researched after expanding existing sample size and determining new predictive factors.
ObjectiveTo explore the value of fluorescence tracer technique in sentinel lymph node (SLN) orientation of cN0 papillary thyroid cancer. MethodsThe total clinical data of 40 cT1-3N0M0 thyroid cancer patients admitted from January 2015 to January 2016 in our hospital were collected, and the SLN with indocyanine green (ICG) as fluorescent trace agent were observed and detected, and the effect of ICG detecting SLN and the guide role of SLNB on the dissection of the central area of neck lymph nodes by intraoperative frozen biopsy pathology and postoperative paraffin pathology were analyzed. ResultsA total of 40 thyroid cancer patients were treated by SLNB and then conducted by the dissection of the central area of neck lymph nodes, and 37 cases detected SLN, so the detection rate was 92.5% (37/40). And a total of 98 SLNs were detected, 1-5 for each case, average of 2.65/case. Intraoperative frozen pathological detected 28 cases of patients with metastases in SLN, and 9 patients without metastasis, including 1 case with postoperative pathology detecting micrometastasis in SLN and other 8 cases without metastasis in the central area of neck lymph nodes. Three cases who were not detected the SLN showed no metastases in final postoperative paraffin pathology. The SLNB of ICG fluorescent tracer was with a sensitivity of 96.6% (28/29), false-negative rate of 3.45% (1/29). ConclusionThe fluorescent tracer technique can guide the dissection of the central of neck lymph node of cN0 thyroid cancer patients accurately with a high detection rate and advantages of high sensitivity in detecting the SLN of thyroid cancer.
ObjectiveTo analyze the predictive factors for central lymph node metastasis in papillary thyroid microcarcinoma (PTMC), and explore the treatment method for the patients with PTMC. MethodThe literatures were reviewed according to the results searched from PubMed in recent years. ResultsCentral lymph node metastases were common in the patients with PTMC. It was important for prophylactic central lymph node dissection so it might reduce the local recurrence and comfirm the clinical staging, further more provide the strategies for the postoperative therapy. ConclusionsLymphadenectomy is necessary for patients with lymph node metastasis. Prophylactic central lymph node dissection should be performed for patients without lymph node metastasis but with one risk factor or more.