Pattern of regional metastasis in papillary thyroid cancer: our experience of 86 cases

Rajjyoti Das; Jagannath D. Sharma; Amal Ch Kataki; Chandi R. Kalita; Nizara Baishya

doi:10.18203/2320-6012.ijrms20193914

Authors

Rajjyoti Das Department of Head and Neck Oncology, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
Jagannath D. Sharma Department of Pathology, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
Amal Ch Kataki Department of Gynecologic Oncology, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
Chandi R. Kalita Department of Hospital Cancer Registry, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
Nizara Baishya Department of Hospital Cancer Registry, Dr. B Borooah Cancer Institute, Guwahati, Assam, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20193914

Keywords:

Central neck dissection, Neck dissection, Nodal metastasis, Papillary Thyroid Cancer, Pattern

Abstract

Background: Papillary thyroid cancer (PTC) have a high propensity for regional metastasis which ranges from 30- 80%. The objective of the study is to assess the pattern of lymph node metastasis and to plan the extent of neck dissection accordingly. Though central neck dissection (CND) is routinely done in PTC but the indication of extent of neck dissection is still controversial.

Methods: The medical records of 86 patients with PTC who underwent total thyroidectomy (TT) and neck dissection at Dr. B. Borooah Cancer Institute(BBCI) from January 2010 to December 2014 were retrospectively reviewed.

Results: Out of 86 patients 22 were males and 64 were females. The median age of presentation was 40.0 years. 43 out of 86 patients (50%) had cervical lymph node metastasis. Ipsilateral nodal metastasis was found in 37 patients (43.0%) and contralateral metastasis was found in only 6 patients (7.0%).Tumors with size more than 3cm had ipsilateral nodal metastasis in 21(56.7%) patients which is statistically significant (p 0.03).A strong association was found between level VI and the ipsilateral group of lymph nodes involving level II,III,IV and V.

Conclusions: Majority of patients present with multiple level nodal metastasis, with the central compartment commonly involved. In view of the high incidence of metastatic lymph nodes in levels II, III, IV and level VI ,our study supports the recommendation for posterolateral and anterior neck dissection in patients with clinically positive neck nodes and tumor with aggressive criteria.

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References

Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA: Cancer J Clinicians. 2010 Sep;60(5):277-300.

Mazzaferri EL, Kloos RT. Current Approaches to Primary Therapy for Papillary and Follicular Thyroid Cancer. J Clin Endocrinol Metab. 2001;86(4):1447-1463.

Machens A, Holzhausen HJ, Dralle H. Skip Metastases in Thyroid Cancer. Leaping the Central Lymph Node Compartment. Arch Surg. 2004;139(1):43-45.

Machens A, Hauptmann S, Dralle H. Lymph Node Dissection in the Lateral Neck for Completion in Central Node-Positive Papillary Thyroid Cancer. Surgery. 2009;145(2):176-181.

El-Foll HA, El-Sebaey HI, El-Kased AF, Hendawy A, Kamel MM. Pattern and Distribution of Lymph Node Metastases in Papillary Thyroid Cancer. J Clin Exp Pathol. 2015;5(1):204.

Moo TA, Fahey TJ. Lymph node dissection in papillary thyroid carcinoma. SeminNucl Med Mar. 2011;41:84-88.

Salter KD, Andersen PE, Cohen J, Schuff KG, Lester L, Shindo M, et al. Central nodal metastasis in papillary thyroid carcinoma based on tumour histologic type and focality. Arch Otolaryngol Head Neck. 2010;136(7):692-96.

Tisell LE. Role of lymphadenectomy in the treatment of thyroid differentiated thyroid carcinomas. Br J Surg.1998;85:1025-26.

Zuniga S, Sanabria A. Prophylactic central neck dissection in stage No papillary thyroid carcinoma. Arch otolaryngol Head Neck Surg. 2009;135(11):1087-91.

Guerrere MA, Suh I, Vriens M R, Shen WT, Gosnell J, Kebebew E, et al. Age and tumor size predicts lymph node involvement in Hurthle Cell Carcinoma. J Cancer. 2010:1:23-6.

Machens A, Holzhausen HJ, Dralle H. The prognostic value of primary tumour size in papillary and follicular thyroid carcinoma. Cancer. 2005;103(11):2269-73.

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 Mar;237(3):399.

Lim YC, Choi EC, Yoon YH, Koo BS. Occult lymph node metastases in neck level V in papillary thyroid carcinoma. Surgery. 2010;147(2):241-5.

Kupferman ME, Weinstock YE, Santillan AA, Mishra A, Roberts D, Clayman GL, et al. Predictors of level V metastasis in well‐differentiated thyroid cancer. Head Neck: J Sci Specialt Head Neck. 2008 Nov;30(11):1469-74.

Machens, MD A, Hinze, MD R, Thomusch, MD O, Dralle, MD H. Pattern of nodal metastasis for primary and reoperative thyroid cancer. World J Surg. 2002 Jan 21;26(1):22-8.