Clinical Study of Neck Lymph Node Dissection in Papillary Thyroid Microcarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Jianming , SU Yanjun , DIAO Chang , CHENG Ruochuan.

Department of Gastrointestinal and Thyroid Surgery, The First Affiliated Hospital of Kunming Medical College, Clinical Institute of Thyroid Surgery in Yunnan Province, Kunming 650032, Yunnan Province, China;

Corresponding author：

Keywords：

Papillary thyroid microcarcinoma; Lymph node metastasis; Neck lymph node dissection; High resolution ultrasonography; Diagnosis

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ObjectiveTo investigate the risk factors for neck lymph node metastasis (LNM) in papillary thyroid microcarcinoma, analyze the diagnostic value of high resolution ultrasonography in lateral neck LNM, and evaluate the safety of lymph node dissection. MethodsThe clinical data of 284 patients with papillary thyroid microcarcinoma from Janaury 2004 to June 2010 in this hospital were analyzed retrospectively. ResultsNeck LNMs were found in 83 of 284 patients (29.2%), only central LNMs in 63 of 284 patients (22.2%), skip LNMs (only lateral LNMs) in 6 of 284 patients (2.1%), and both central and lateral LNMs in 14 of 284 patients (4.9%). Age lt;45 years, multifocality, tumor diameter ≥5 mm, and extrathyroidal invasion were the risk factors for LNM (P lt;0.05), and no risk factor for skip LNM was found. Patients underwent central and lateral lymph node dissection had longer postoperative hospital stay than those without dissection or with central lymph node dissection only (P lt;0.05). Both parathyroid gland and recurrent laryngeal nerve injuries were temporary postoperatively. There were no differences in injury rate among three methods (P gt;0.05). The sensitivity, specificity, false negative rate, and false positive rate of high resolution ultrasonography for only lateral neck LNM were 95.0%, 75.0%, 5.0%, and 25.0%, repectively. The positive predictive value and negative predictive value were 90.5% and 85.7%, respectively. ConclusionsTotal thyroidectomy should be performed in patients with risk factors for LNM, and simultaneous central lymph node dissection is safe. High resolution ultrasonography is of great value in diagnosing skip LNM, and functional lymph node dissection also should be applied in patients who are highly suspected to have skip LNM.

Citation： ZHANG Jianming,SU Yanjun,DIAO Chang,CHENG Ruochuan.. Clinical Study of Neck Lymph Node Dissection in Papillary Thyroid Microcarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(4): 414-418. doi: Copy

1.	Harach HR, Franssila KO, Wasenius VM. Occult papillary carcinoma of the thyroid. A “normal” finding in Finland. A systematic autopsy study [J]. Cancer, 1985, 56(3): 531538.
2.	Lin JD, Kuo SF, Chao TC, et al. Incidental and nonincidental papillary thyroid microcarcinoma [J]. Ann Surg Oncol, 2008, 15(8): 22872292.
3.	Grodski S, Delbridge L. An update on papillary microcarcinoma [J]. Curr Opin Oncol, 2009, 21(1): 14.
4.	徐晓波, 刘文勇. 结节性甲状腺肿合并甲状腺微小癌42例分析 [J]. 中国普外基础与临床杂志, 2011, 18(2): 196197.
5.	Besic N, Pilko G, Petric R, et al. Papillary thyroid microcarcinoma: prognostic factors and treatment [J]. J Surg Oncol, 2008, 97(3): 221225.
6.	Zafon C, Baena JA, Castellví J, et al. Differences in the form of presentation between papillary microcarcinomas and papillary carcinomas of larger size [J]. J Thyroid Res, 2010, 2011: 639156.
7.	Lim YC, Choi EC, Yoon YH, et al. Central lymph node metastases in unilateral papillary thyroid microcarcinoma [J]. Br J Surg, 2009, 96(3): 253257.
8.	Chung YS, Kim JY, Bae JS, et al. Lateral lymph node metastasis in papillary thyroid carcinoma: results of therapeutic lymph node dissection [J]. Thyroid, 2009, 19(3): 241246.
9.	Choi SJ, Kim TY, Lee JC, et al. Is routine central neck dissection necessary for the treatment of papillary thyroid microcarcinoma? [J]. Clin Exp Otorhinolaryngol, 2008, 1(1): 4145.
10.	Roh JL, Kim JM, Park CI. Central cervical nodal metastasis from papillary thyroid microcarcinoma: pattern and factors predictive of nodal metastasis [J]. Ann Surg Oncol, 2008, 15(9): 24822486.
11.	Roh JL, Park JY, Park CI. Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone [J]. Ann Surg, 2007, 245(4): 604610.
12.	Machens A, Holzhausen HJ, Dralle H. Skip metastases in thyroid cancer leaping the central lymph node compartment [J]. Arch Surg, 2004, 139(1): 4345.
13.	Roh JL, Kim JM, Park CI. Lateral cervical lymph node metastases from papillary thyroid carcinoma: pattern of nodal metastases and optimal strategy for neck dissection [J]. Ann Surg Oncol, 2008, 15(4): 11771182.
14.	Coatesworth AP, MacLennan K. Cervical metastasis in papillary carcinoma of the thyroid: a histopathological study [J]. Int J Clin Pract, 2002, 56(4): 241242.
15.	Wada N, Duh QY, Sugino K, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection [J]. Ann Surg, 2003, 237(3): 399407.
16.	Chow SM, Law SC, Chan JK, et al. Papillary microcarcinoma of the thyroid-Prognostic significance of lymph node metastasis and multifocality [J]. Cancer, 2003, 98(1): 3140.
17.	Ito Y, Tomoda C, Uruno T, et al. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid [J]. World J Surg, 2006, 30(1): 9199.
18.	Kim TY, Hong SJ, Kim JM, et al. Prognostic parameters for recurrence of papillary thyroid microcarcinoma [J]. BMC Cancer, 2008, 8: 296.
19.	Ali S, Tiwari RM, Snow GB. Falsepositive and falsenegative neck nodes [J]. Head Neck Surg, 1985, 8(2): 7882.
20.	Stulak JM, Grant CS, Farley DR, et al. Value of preoperative ultrasonography in the surgical management of initial and reoperative papillary thyroid cancer [J]. Arch Surg, 2006, 141(5): 489494.
21.	Hwang HS, Orloff LA. Efficacy of preoperative neck ultrasound in the detection of cervical lymph node metastasis from thyroid cancer [J]. Laryngoscope, 2011, 121(3): 487491.
22.	Kim E, Park JS, Son KR, et al. Preoperative diagnosis of cervical metastatic lymph nodes in papillary thyroid carcinoma: comparison of ultrasound, computed tomography, and combined ultrasound with computed tomography [J]. Thyroid, 2008, 18(4): 411418.
23.	Pereira JA, Jimeno J, Miquel J, et al. Nodal yield, morbidity, and recurrence after central neck dissection papillary thyroid carcinoma [J]. Surgery, 2005, 138(6): 10951100.
24.	程若川, 苏艳军, 张建明, 等. 甲状腺手术方式和喉返神经显露与神经损伤的关系 [J]. 中国普通外科杂志, 2007, 16(1): 1517.
25.	Mercante G, Frasoldati A, Pedroni C, et al. Prognostic factors affecting neck lymph node recurrence and distant metastasis in papillary microcarcinoma of the thyroid: results of a study in 445 patients [J]. Thyroid, 2009, 19(7): 707716.
26.	程若川, 艾杨卿, 刁畅, 等. 甲状腺手术中甲状旁腺显露及功能保护的临床研究 [J]. 中国普外基础与临床杂志, 2009, 16(5): 351355.
27.	程若川, 苏艳军, 刁畅, 等. 高分化甲状腺癌再手术原因和颈淋巴结转移的危险因素分析 [J]. 国际外科学杂志, 2010, 37(2): 9598.

1. Harach HR, Franssila KO, Wasenius VM. Occult papillary carcinoma of the thyroid. A “normal” finding in Finland. A systematic autopsy study [J]. Cancer, 1985, 56(3): 531538.
2. Lin JD, Kuo SF, Chao TC, et al. Incidental and nonincidental papillary thyroid microcarcinoma [J]. Ann Surg Oncol, 2008, 15(8): 22872292.
3. Grodski S, Delbridge L. An update on papillary microcarcinoma [J]. Curr Opin Oncol, 2009, 21(1): 14.
4. 徐晓波, 刘文勇. 结节性甲状腺肿合并甲状腺微小癌42例分析 [J]. 中国普外基础与临床杂志, 2011, 18(2): 196197.
5. Besic N, Pilko G, Petric R, et al. Papillary thyroid microcarcinoma: prognostic factors and treatment [J]. J Surg Oncol, 2008, 97(3): 221225.
6. Zafon C, Baena JA, Castellví J, et al. Differences in the form of presentation between papillary microcarcinomas and papillary carcinomas of larger size [J]. J Thyroid Res, 2010, 2011: 639156.
7. Lim YC, Choi EC, Yoon YH, et al. Central lymph node metastases in unilateral papillary thyroid microcarcinoma [J]. Br J Surg, 2009, 96(3): 253257.
8. Chung YS, Kim JY, Bae JS, et al. Lateral lymph node metastasis in papillary thyroid carcinoma: results of therapeutic lymph node dissection [J]. Thyroid, 2009, 19(3): 241246.
9. Choi SJ, Kim TY, Lee JC, et al. Is routine central neck dissection necessary for the treatment of papillary thyroid microcarcinoma? [J]. Clin Exp Otorhinolaryngol, 2008, 1(1): 4145.
10. Roh JL, Kim JM, Park CI. Central cervical nodal metastasis from papillary thyroid microcarcinoma: pattern and factors predictive of nodal metastasis [J]. Ann Surg Oncol, 2008, 15(9): 24822486.
11. Roh JL, Park JY, Park CI. Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone [J]. Ann Surg, 2007, 245(4): 604610.
12. Machens A, Holzhausen HJ, Dralle H. Skip metastases in thyroid cancer leaping the central lymph node compartment [J]. Arch Surg, 2004, 139(1): 4345.
13. Roh JL, Kim JM, Park CI. Lateral cervical lymph node metastases from papillary thyroid carcinoma: pattern of nodal metastases and optimal strategy for neck dissection [J]. Ann Surg Oncol, 2008, 15(4): 11771182.
14. Coatesworth AP, MacLennan K. Cervical metastasis in papillary carcinoma of the thyroid: a histopathological study [J]. Int J Clin Pract, 2002, 56(4): 241242.
15. Wada N, Duh QY, Sugino K, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection [J]. Ann Surg, 2003, 237(3): 399407.
16. Chow SM, Law SC, Chan JK, et al. Papillary microcarcinoma of the thyroid-Prognostic significance of lymph node metastasis and multifocality [J]. Cancer, 2003, 98(1): 3140.
17. Ito Y, Tomoda C, Uruno T, et al. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid [J]. World J Surg, 2006, 30(1): 9199.
18. Kim TY, Hong SJ, Kim JM, et al. Prognostic parameters for recurrence of papillary thyroid microcarcinoma [J]. BMC Cancer, 2008, 8: 296.
19. Ali S, Tiwari RM, Snow GB. Falsepositive and falsenegative neck nodes [J]. Head Neck Surg, 1985, 8(2): 7882.
20. Stulak JM, Grant CS, Farley DR, et al. Value of preoperative ultrasonography in the surgical management of initial and reoperative papillary thyroid cancer [J]. Arch Surg, 2006, 141(5): 489494.
21. Hwang HS, Orloff LA. Efficacy of preoperative neck ultrasound in the detection of cervical lymph node metastasis from thyroid cancer [J]. Laryngoscope, 2011, 121(3): 487491.
22. Kim E, Park JS, Son KR, et al. Preoperative diagnosis of cervical metastatic lymph nodes in papillary thyroid carcinoma: comparison of ultrasound, computed tomography, and combined ultrasound with computed tomography [J]. Thyroid, 2008, 18(4): 411418.
23. Pereira JA, Jimeno J, Miquel J, et al. Nodal yield, morbidity, and recurrence after central neck dissection papillary thyroid carcinoma [J]. Surgery, 2005, 138(6): 10951100.
24. 程若川, 苏艳军, 张建明, 等. 甲状腺手术方式和喉返神经显露与神经损伤的关系 [J]. 中国普通外科杂志, 2007, 16(1): 1517.
25. Mercante G, Frasoldati A, Pedroni C, et al. Prognostic factors affecting neck lymph node recurrence and distant metastasis in papillary microcarcinoma of the thyroid: results of a study in 445 patients [J]. Thyroid, 2009, 19(7): 707716.
26. 程若川, 艾杨卿, 刁畅, 等. 甲状腺手术中甲状旁腺显露及功能保护的临床研究 [J]. 中国普外基础与临床杂志, 2009, 16(5): 351355.
27. 程若川, 苏艳军, 刁畅, 等. 高分化甲状腺癌再手术原因和颈淋巴结转移的危险因素分析 [J]. 国际外科学杂志, 2010, 37(2): 9598.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Study of Neck Lymph Node Dissection in Papillary Thyroid Microcarcinoma

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