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Isthmic Papillary Thyroid Carcinoma Presents a Unique Pattern of Central Lymph Node Metastasis

Authors Zhou L, Gao C, Li H, Liang W, Zeng Q, Chen B

Received 6 March 2020

Accepted for publication 1 May 2020

Published 19 May 2020 Volume 2020:12 Pages 3643—3650


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Rudolph Navari

Liguang Zhou,1,2 Chao Gao,3 Haipeng Li,4 Weili Liang,3 Qingdong Zeng,3 Bo Chen3

1Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, People’s Republic of China; 2Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China; 3Department of Thyroid Surgery, General Surgery, Qilu Hospital, Shandong University, Jinan 250012, People’s Republic of China; 4Department of General Surgery, Cao County People’s Hospital, Heze, People’s Republic of China

Correspondence: Bo Chen Email

Purpose: Treatment protocols for occult central lymph node metastasis (LNM) associated with papillary thyroid cancer (PTC) located in the isthmus are debatable. We aimed to analyze the pattern of occult central LNM in isthmic PTC, including risk factors for bilateral paratracheal LNM.
Patients and Methods: Consecutive patients with PTC were recruited to this study. All patients underwent total thyroidectomy and prophylactic bilateral central neck dissection. The clinicopathologic features and distribution of central LNM were compared between the two groups, and risk factors for bilateral paratracheal LNM were analyzed.
Results: A total of 174 patients with PTC were enrolled in this study, of whom 87 patients had isthmic PTC (study group) and 87 patients had lobe-originating PTC (control group). The two groups had comparable demographics and tumor features. There were higher frequencies of pretracheal LNM (P =0.001) and bilateral paratracheal LNM (P = 0.002) in the isthmic PTC group. Bilateral paratracheal LNM was significantly associated with age < 55 years (P = 0.037), capsular invasion (P = 0.034), tumor location (isthmus) (P < 0.001), BRAF gene mutation (P = 0.013), and pretracheal LNM (P < 0.001). Isthmus location (odds ratio [OR]: 4.116, 95% confidence interval [CI]: 1.264– 13.433, P = 0.019) and pretracheal LNM (OR: 3.422, 95% CI: 1.214– 9.642, P = 0.020) were independent risk factors for bilateral paratracheal LNM.
Conclusion: Because of its unique anatomic location, isthmic PTC differs from PTC in the lobe with respect to pretracheal and bilateral paratracheal LNM, even in patients of comparable age, sex, tumor size, extrathyroidal extension, BRAF mutation, and pathologic TNM staging. The isthmus location was found to be an independent risk factor for bilateral paratracheal LNM. This information may contribute to the development of an appropriate surgical protocol for isthmic PTC.

Keywords: tumor location, bilateral paratracheal sub-compartments, risk factors

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