Document Type : Original Research

Authors

Department of General Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

Abstract

Background & Objective: Papillary thyroid cancer (PTC) is the most common primary cancer originating from thyroid follicular cells. The aim of this study was to evaluate the positive predictors of micrometastasis in central lymph nodes in patients with papillary thyroid cancer.
Methods: This was a cross-sectional study. The study population was all known PTC patients who underwent total thyroidectomy and lymph node dissection of the central neck nodes based on the current indications. Confirmation of central lymph node involvement was performed by permanent smear after surgery. Data were analyzed using SPSS software version 22. A P-value below 0.05 was considered statistically significant.
Results: There was no significant relationship between age, gender, family history of PTC, family history of thyroid disease, multinodularity, history of other thyroid diseases, involvement of two thyroid lobes, and tumor grade with central lymph node involvement (P>0.05). There was a significant relationship between the tumor pathology and size with central lymph node involvement (P<0.05). Moreover, logistic multivariate regression analysis showed that female gender, multinodularity, and tumor size had a significant relationship with the incidence of central lymph node involvement (P<0.05).  
Conclusion: Female gender, multinodularity, and larger tumor size may be predictors of micrometastasis in central lymph nodes in patients with papillary thyroid cancer.

Keywords

Main Subjects

  1. Ab Mutalib NS, Othman SN, Mohamad Yusof A, Abdullah Suhaimi SN, Muhammad R, Jamal R. Integrated microRNA, gene expression and transcription factors signature in papillary thyroid cancer with lymph node metastasis. Peer J. 2016;4:e2119. [DOI:10.7717/peerj.2119] [PMID] [PMCID]
  2. Nath MC, Erickson LA. Aggressive Variants of Papillary Thyroid Carcinoma: Hobnail, Tall Cell, Columnar, and Solid. Adv Anat Pathol. 2018;25 (3):172-9. [DOI:10.1097/PAP.0000000000000184] [PMID]
  3. Mao J, Zhang Q, Zhang H, Zheng K, Wang R, Wang G. Risk Factors for Lymph Node Metastasis in Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne). 2020;11:265. [PMID] [PMCID] [DOI:10.3389/fendo.2020.00265]
  4. Koshkina A, Fazelzad R, Sugitani I, Miyauchi A, Thabane L, Goldstein DP, et al. Association of Patient Age With Progression of Low-risk Papillary Thyroid Carcinoma Under Active Surveillance: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg. 2020;146(6):552-60. [PMID] [PMCID] [DOI:10.1001/jamaoto.2020.0368]
  5. Yu J, Deng Y, Liu T, Zhou J, Jia X, Xiao T, et al. Lymph node metastasis prediction of papillary thyroid carcinoma based on transfer learning radiomics. Nat Commun. 2020;11(1):4807. [DOI:10.1038/s41467-020-18497-3] [PMID] [PMCID]
  6. Liu C, Xiao C, Chen J, Li X, Feng Z, Gao Q, et al. Risk factor analysis for predicting cervical lymph node metastasis in papillary thyroid carcinoma: a study of 966 patients. BMC Cancer. 2019;19(1):622. [DOI:10.1186/s12885-019-5835-6] [PMID] [PMCID]
  7. Grigsby PW, Reddy RM, Moley JF, Hall BL. Contralateral papillary thyroid cancer at completion thyroidectomy has no impact on recurrence or survival after radioiodine treatment. Surgery. 2006;140(6):1043-9. [DOI:10.1016/j.surg.2006.08.007] [PMID]
  8. Zhao H, Huang T, Li H. Risk factors for skip metastasis and lateral lymph node metastasis of papillary thyroid cancer. Surgery. 2019;166(1): 55-60. [DOI:10.1016/j.surg.2019.01.025] [PMID]
  9. Lo CY, Chan WF, Lam KY, Wan KY. Optimizing the treatment of AMES high-risk papillary thyroid carcinoma. World J Surg. 2004;28(11):1103-9. [DOI:10.1007/s00268-004-7420-6] [PMID]
  10. Sebastian SO, Gonzalez JM, Paricio PP, Perez JS, Flores DP, Madrona AP, et al. Papillary thyroid carcinoma: prognostic index for survival including the histological variety. Arch Surg. 2000;135(3):272-7. [DOI:10.1001/archsurg.135.3.272] [PMID]
  11. Yang Z, Heng Y, Lin J, Lu C, Yu D, Tao L, et al. Nomogram for Predicting Central Lymph Node Metastasis in Papillary Thyroid Cancer: A Retrospective Cohort Study of Two Clinical Centers. Cancer Res Treat. 2020;52(4):1010-8. [DOI:10.4143/crt.2020.254] [PMID] [PMCID]
  12. Pasieka JL, Thompson NW, McLeod MK, Burney RE, Macha M. The incidence of bilateral well-differentiated thyroid cancer found at completion thyroidectomy. World J Surg. 1992;16(4):711-6; discussion 6-7. [DOI:10.1007/BF02067365] [PMID]
  13. Ma B, Wei W, Xu W, Wang Y, Guan H, Fan J, et al. Surgical Confirmation of Incomplete Treatment for Primary Papillary Thyroid Carcinoma by Percutaneous Thermal Ablation: A Retrospective Case Review and Literature Review. Thyroid. 2018;28(9):1134-42. [DOI:10.1089/thy.2017.0558] [PMID]
  14. Zhao H, Li H. Meta-analysis of ultrasound for cervical lymph nodes in papillary thyroid cancer: Diagnosis of central and lateral compartment nodal metastases. Eur J Radiol. 2019;112:14-21. [DOI:10.1016/j.ejrad.2019.01.006] [PMID]
  15. Hughes DT, Rosen JE, Evans DB, Grubbs E, Wang TS, Solorzano CC. Prophylactic Central Compartment Neck Dissection in Papillary Thyroid Cancer and Effect on Locoregional Recurrence. Ann Surg Oncol. 2018;25(9):2526-34. [DOI:10.1245/s10434-018-6528-0] [PMID]
  16. Feng JW, Yang XH, Wu BQ, Sun DL, Jiang Y, Qu Z. Predictive factors for central lymph node and lateral cervical lymph node metastases in papillary thyroid carcinoma. Clin Transl Oncol. 2019;21(11):1482-91. [DOI:10.1007/s12094-019-02076-0] [PMID]
  17. Chen L, Wu YH, Lee CH, Chen HA, Loh EW, Tam KW. Prophylactic Central Neck Dissection for Papillary Thyroid Carcinoma with Clinically Uninvolved Central Neck Lymph Nodes: A Systematic Review and Meta-analysis. World J Surg. 2018;42(9):2846-57. [DOI:10.1007/s00268-018-4547-4] [PMID]
  18. Zhu J, Zheng J, Li L, Huang R, Ren H, Wang D, et al. Application of Machine Learning Algorithms to Predict Central Lymph Node Metastasis in T1-T2, Non-invasive, and Clinically Node Negative Papillary Thyroid Carcinoma. Front Med (Lausanne). 2021;8: 635771. [DOI:10.3389/fmed.2021.635771] [PMID] [PMCID]
  19. Zhou B, Qin J. High-risk factors for lymph node metastasis in contralateral central compartment in unilateral papillary thyroid carcinoma (cT1N0). Eur J Surg Oncol. 2021;47(4):882-7. [DOI:10.1016/j.ejso.2020.10.018] [PMID]
  20. Seong CY, Chai YJ, Lee SM, Kim S-j, Choi JY, Lee KE, et al. Significance of distance between tumor and thyroid capsule as an indicator for central lymph node metastasis in clinically node negative papillary thyroid carcinoma patients. Plos One. 2018;13(7):e0200166. [PMID] [PMCID] [DOI:10.1371/journal.pone.0200166]
  21. Zhou YL, Gao EL, Zhang W, Yang H, Guo GL, Zhang XH, et al. Factors predictive of papillary thyroid micro-carcinoma with bilateral involvement and central lymph node metastasis: a retrospective study. World J Surg Oncol. 2012;10(1):67. [DOI:10.1186/1477-7819-10-67] [PMID] [PMCID]
  22. Kim K-E, Kim E-K, Yoon JH, Han KH, Moon HJ, Kwak JY. Preoperative prediction of central lymph node metastasis in thyroid papillary microcarcinoma using clinicopathologic and sonographic features. World J Surg. 2013;37 (2):385-91. [DOI:10.1007/s00268-012-1826-3] [PMID]
  23. Howell GM, Nikiforova MN, Carty SE, Armstrong MJ, Hodak SP, Stang MT, et al. BRAF V600E mutation independently predicts central compartment lymph node metastasis in patients with papillary thyroid cancer. Ann Surg Oncol. 2013;20(1):47-52. [DOI:10.1245/s10434-012-2611-0] [PMID]
  24. Wang LY, Palmer FL, Nixon IJ, Thomas D, Shah JP, Patel SG, et al. Central lymph node characteristics predictive of outcome in patients with differentiated thyroid cancer. Thyroid. 2014; 24(12):1790-5. [DOI:10.1089/thy.2014.0256] [PMID]
  25. Chang YW, Kim HS, Jung SP, Kim HY, Lee JB, Bae JW, et al. Significance of micrometastases in the calculation of the lymph node ratio for papillary thyroid cancer. Ann Surg Treat Res. 2017;92(3):117-22. [PMID] [PMCID] [DOI:10.4174/astr.2017.92.3.117]
  26. Cho SY, Lee TH, Ku YH, Kim HI, Lee GH, Kim MJ. 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. Surgery. 2015;157(1):111-8. [DOI:10.1016/j.surg.2014.05.023] [PMID]
  27. Prstačić R, Bumber B, Marjanović Kavanagh M, Jurlina M, Ivković I, Prgomet D. Metastasis predictors for neck sublevel IIb in papillary thyroid carcinoma. Clin Otolaryngol. 2020;45(5): 710-7. [DOI:10.1111/coa.13562] [PMID]
  28. Mazzaferri EL, Doherty GM, Steward DL. The pros and cons of prophylactic central compartment lymph node dissection for papillary thyroid carcinoma. Thyroid. 2009;19(7):683-9. [DOI:10.1089/thy.2009.1578] [PMID]
  29. Moghimi M, Shahrbabaki PB. Evaluation of risk factor for microscopic involvement of cervical central lymph nodes in patients with papillary thyroid carcinoma who are clinically node negative. 2017.
  30. Choi YJ, Yun JS, Kook SH, Jung EC, Park YL. Clinical and imaging assessment of cervical lymph node metastasis in papillary thyroid carcinomas. World J Surg. 2010;34(7):1494-9. [DOI:10.1007/s00268-010-0541-1] [PMID]