Preoperative Sonographic and Clinicopathological Predictors for Solitary Lateral Neck Node Metastasis in Papillary Thyroid Carcinoma: A Retrospective Study
Received 2 January 2020
Accepted for publication 27 February 2020
Published 12 March 2020 Volume 2020:12 Pages 1855—1862
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Xueqiong Zhu
Qiong Yang,1 Pei Chen,1 Hui-Yu Hu,1 Hai-long Tan,1 Gui-you Li,1 Mian Liu,1 Deng-jie Ou-yang,1 Rooh-afza Khushbu,1 Deepak Pun,1 Zhi-peng Zhang,2 Peng Huang,1 Shi Chang1
1Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China; 2Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
Correspondence: Peng Huang; Shi Chang
Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
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Background: Cervical lymph node metastasis (LNM) is an independent risk factor for poor prognosis of papillary thyroid carcinoma (PTC), but the scope of PTC lateral neck dissection (LND) is controversial. Solitary lateral lymph node metastasis (SLNM) is a special type of PTC with lateral LNM. Currently, study on the preoperative clinical characteristics of SLNM has been seldomly reported. This study evaluated the preoperative characteristics for predicting the SLNM of PTC.
Methods: We included 391 patients diagnosed with PTC between May 2011 and July 2017. Among those patients, 44 had SLNM and 347 had multiple lateral neck node metastasis (MLNM). The clinicopathologic characteristics and other central lymph node metastasis risk factors were retrospectively analyzed.
Results: Univariate analysis revealed that age and tumor size (≤ 1 cm) were significantly correlated with SLNM. In ROC curve analysis, the optimal cutoff age of preoperative predictors for the prediction of SLNM was 46.5 years (AUC=0.623, 0.536– 0.710). Besides, the frequency and mean number of CLNM was significantly less in the SLNM than MLNM group. The oval and round tumor shape and well-defined margin of the tumor were more common in the SLNM group (p =0.001; p=0.024, respectively). In addition, multivariate analysis revealed that age ≥ 47, capsular invasion, no extrathyroidal extension, with central lymph node metastases and irregular shape were independent SLNM predictors of PTCs (odds ratio 2.386, 0.173, 0.284, 0.239, 0.188; 95% CI 1.07– 5.140, 0.058– 0.840, 0.066– 0.926, 0.091– 0.437, 0.167– 0.864, respectively).
Conclusion: This study supported that SLNM is more likely to happen in PTC patients with age ≥ 47 years, capsular invasion, no extrathyroidal extension, with central lymph node metastases and irregular shape. That denotes, selective single level neck dissection can be considered as an alternative to systemic lateral neck dissection in those patients.
Keywords: solitary lateral lymph node metastasis, papillary thyroid carcinoma, central lymph node dissection
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