ObjectiveTo investigate the risk factors affecting cervical central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM) in patients with papillary thyroid carcinoma (PTC). MethodsThe patients with newly diagnosed with PTC who underwent surgical treatment in this hospital from April 2020 to December 2023 were included. The univariate and multivariate logistic regression analyses were conducted to identify the risk factors affecting the occurrences of CLNM and LLNM in patients with PTC and a prediction model was developed using these risk factors. Additionally, the discriminatory power of the predictive model for CLNM or LLNM was evaluated using the area under the receiver operating characteristic curve (AUC). ResultsA total of 297 patients with PTC were included in this study, among whom 149 (50.2%) cases developed CLNM, and 41 (13.8%) cases developed LLNM. The multivariate analysis indicated that the male, age <36 years old, and maximum tumor diameter >5 mm were the independent risk factors for CLNM in the patients with PTC (P<0.05). The independent risk factors for LLNM in the patients with PTC were the age ≥59 years old, bilateral or isthmus distribution of cancer foci, maximum tumor diameter >5 mm, and invasion of capsule (P<0.05). The AUC (95%CI) of the CLNM prediction model, constructed using three risk factors (gender, age, and maximum tumor diameter), was 0.693 (0.633, 0.752). For the LLNM prediction model, which incorporated four factors [age, distribution of cancer foci, maximum tumor diameter, and capsular invasion], the AUC (95%CI) was 0.776 (0.707, 0.846). ConclusionsThe findings of this study suggest that younger male patients with PTC (age <36 years), and a maximum tumor diameter >5 mm have a higher risk of CLNM. However, the predictive model constructed for CLNM demonstrates only moderate discriminatory power. In contrast, elderly patients (age ≥59 years old) with PTC exhibiting a maximum tumor diameter >5 mm, capsular invasion, and bilateral (or isthmus) lesions are at greater risk of LLNM. The predictive model developed for LLNM shows a certain discriminatory performance.
ObjectiveTo establish a predictive model for neck lateral lymph node metastasis (LLNM) in unilateral papillary thyroid cancer (uni-PTC) with central lymph node metastasis (CLNM). MethodsThe uni-PTC patients with CLNM were included in this study. The patients underwent thyroid surgery in the 960th Hospital of the PLA Joint Logistics Support Force from May 2018 to December 2021, who were randomly divided into the modeling group and the validation group according to the ratio of 7∶3. The risk factors of neck LLNM were analyzed by univariate and multivariate logistic regression and the nomogram of prediction model was constructed. The receiver operating characteristic (ROC) curve and calibration curve were used to validate the prediction model. ResultsA total of 237 patients were included in this study, including 158 patients in the modeling group and 79 patients in the validation group. The LLNM occurred in the 84 patients of the modeling group and 43 patients of the validation group. The multivariate logistic regression analysis was performed according to the statistical indicators in the univariate analysis results of the modeling group and the risk factors considered in the previous studies. The results showed that the patients with maximum diameter of the lesions >1 cm, multiple lesions, extraglandular invasion, the rate of CLNM ≥0.414, and lesions located at the upper portion had higher probability of LLNM (OR>1, P<0.05). The area under ROC curve of the nomogram in predicting LLNM in the modeling group was 0.834 [95%CI (0.771, 0.896)], which in the validation group was 0.761 [95%CI (0.651, 0.871)]. The calibration curve showed a good calibration degree in the prediction model. ConclusionThe clinical risk prediction model established based on the risk factors can better predict the probability of LLNM.
ObjectiveTo evaluate the safty of recurrent laryngeal nerve (RLN) and parathyroid if Pseudomonas aeruginosa injection (PAI) is used after total thyroidectomy and central neck dissection (CND).MethodsFrom Mar. 2016 to Oct. 2017, we recruited 113 patients with papillary thyroid cancer (PTC) who accepted total thyroidectomy and CND. During operation, 1 mL of PAI was applied in 58 patients (local spray group) and 55 not (control group). The hoarseness, hypoparathyroidism, chylous fistula, drainage volume, hospital stay, and incidence of complications were compared between the two groups.ResultsThe two groups embraced few difference in age, gender, BMI, tumor site, the diameter of tumor and the number of metastatic and the harvested lymph nodes (P>0.05). There were nobody who has suffered in hoarseness and permanent hypoparathyroidism in both groups at any time after operation. There was no significant differences of complication between the two groups. The drainage volume at 24 h after operation in the local spraying group was more than that in the control group, and the difference was statistically significant (P=0.023). There were 2 patients had chylous fistula after surgery in the control group but none in the local spray group. The total volumes of drainage, incidence of fever and incision infection, the mean stay in the hospital, and the postoperative pain score had no statistic significance in the both groups.ConclusionAfter total thyroidectomy and CND, local spraying of PAI in the wound cavity is safe and will not damage the recurrent laryngeal nerve.
ObjectiveTo investigate the predictive value of pretracheal lymph node (Ⅵc) subdivision for contralateral central lymph node (CLN) metastasis in clinical lymph node negative (cN0) unilateral papillary thyroid carcinoma (PTC). MethodsThe data of patients with cN0 unilateral PTC who initially underwent total thyroidectomy and bilateral CLN dissection in the Department of Thyroid Surgery of West China Hospital, Sichuan University from July 2017 to June 2021 were collected retrospectively. The Ⅵc subdivision was divided into right anterior trachea (Ⅵc1) and left anterior trachea (Ⅵc2); If the lymph nodes crossed the middle line of trachea, which would be included in the side of cancer focus. ResultsA total of 175 patients were included in this study, and the incidences of lymph nodes metastasis in the prelaryngeal (Ⅵd), Ⅵc, ipsilateral Ⅵc, contralateral Ⅵc, ipsilateral central, and contralateral central regions were 54 cases (30.9%), 118 cases (67.4%), 85 cases (48.6%), 72 cases (41.1%), 108 cases (61.7%), and 43 cases (24.6%), respectively. The results of the univariate analysis found that the contralateral CLN metastasis was associated with the lymph node metastases of Ⅵd, Ⅵc, contralateral Ⅵc, and ipsilateral central regions; The results of the multivariate analysis found that the lymph node metastases of Ⅵd and contralateral Ⅵc regions increased the probability of contralateral CLN metastasis (OR=4.444, P<0.001; OR=6.655, P=0.001). ConclusionsFrom the results of the study,Ⅵc subdivision is reasonable and effective, and has a certain predictive value for the metastasis of contralateral CLN in cN0 unilateral papillary thyroid carcinoma. And bilateral CLN dissection should be recommended in patients with a positive intraoperative frozen section result of contralateral pretracheal lymph node metastasis.
Objective To explore the risk factors the central cervical lymph node micrometastasis of papillary thyroid microcarcinoma (PTMC). Methods PTMC patients who underwent surgical operations in West China Hospital, Sichuan University between January 2014 and December 2018 were retrospectively enrolled. The patient did not find lymph node metastasis in the central cervical area by preoperative ultrasound. During the operation, the central cervical lymph node of the affected side was dissected or lymph node dissection in the central area of the affected side of the neck plus the lateral area of the neck. With postoperative pathology as the gold standard, patients were divided into central cervical lymph node micrometastasis group (micrometastasis group) and central cervical lymph node non-metastasis group (non-metastasis group). The differences of clinical features and ultrasonic signs between the two groups were analyzed. Results A total of 507 patients were included, including 223 (44.0%) in the micrometastasis group and 284(56.0%) in the non-metastasis group. The results of univariate analysis showed that compared with the non-metastasis group, the patients in the micrometastasis group were younger, the tumor size were higher, the proportion of male, multifocality, bilateral involvement and thyroid capsular invasion were higher. The results of multiple logistic regression analysis showed that lower age [odds radio (OR)=0.967, 95% confidence interval (CI)(0.949, 0.985), P<0.001], male [OR=2.357, 95%CI (1.503, 3.694), P<0.001)], a larger maximum diameter of PTMC [OR=1.232, 95%CI (1.100, 1.379), P<0.001], a larger nodule volume of PTMC [OR=1.031, 95%CI (1.008, 1.114), P=0.032], multifocal lesion [OR=2.309, 95%CI (1.167, 4.570), P=0.016] and invasion of the thyroid capsule [OR=1.520, 95%CI (1.010, 2.286), P=0.045] were independent risk factors for central cervical lymph node micrometastasis. Conclusions The patient’s male, young age, PTMC nodule with large maximum diameter and large volume, multifocal, and invasion of the thyroid membrane are risk factors for the central cervical lymph node micrometastasis of PMTC patients. These clinical and ultrasound signs can provide a theoretical basis for doctors’ clinical management decisions.
ObjectiveTo investigate the value of central lymph node dissection in patients with cN0 papillary thyroid carcinoma. MethodThe clinical data of 128 patients with cN0 papillary thyroid carcinoma who had been performed central lymph node dissection during their hospitalization from December 2010 to July 2012 in Chinese PLA General Hospital were analyzed retrospectively. ResultsThe central neck lymph node metastasis rate was 35.94%(46/128) in 128 patients with cN0 papillary thyroid carcinoma, which in the patients with aged less than 45 years, with the tumor diameter larger than 1 cm, and with capsule or extrathyroidal invasion were significantly higher than those in the patients with aged larger than 45 years, with the tumor diameter less than 1 cm, and without capsule or extrathyroidal invasion (P < 0.05). After the operation, there were 22(17.19%) patients with temporary hypoparathyroidism as well as 3(2.34%) patients with temporary recurrent laryngeal nerve injury. However, no permanent recurrent laryngeal nerve injury and permanent hypoparathyroidism occurred. During the 14-32 months follow-up with an average 23.4 months, 2 cases of lateral neck lymph node metastases were observed. ConclusionAs an essential, effective, and safe operation to the patients with cN0 papillary thyroid carcinoma, central lymph node dissection should be performed by experienced hands.
Objective To investigate the value of sentinel lymph node biopsy (SLNB) in predicting the metastasis of central cervical lymph nodes (CCLN) in differentiated thyroid carcinoma, and to explore reasonable program for CCLN dissection. Methods This retrospective analysis was performed basing on the clinical data of 407 patients with differentiated thyroid carcinoma who were admitted to the Department of General Surgery of Xuanwu Hospital from June 2013 to December 2016, including 237 patients with microcarcinoma. Results ① The results of the lymph nodes detection. All patients had detected 7 766 lymph nodes (1 238 metastatic lymph nodes were detected from 219 patients), and 2 085 sentinel lymph nodes were detected (448 metastatic sentinel lymph nodes were detected from 189 patients). In the patients with microcarcinoma, there were 3 614 lymph nodes were detected (390 metastatic lymph nodes were detected from 97 patients), and 1 202 sentinel lymph nodes were detected (149 metastatic sentinel lymph nodes were detected from 82 patients). ② The value of SLNB to predict CCLN metastasis. The sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of SLNB to predict CCLN metastasis for all patients was 86.30% (189/219), 100% (188/188), 0 (0/189), 13.70% (30/219), 100% (189/189), and 86.24% (188/218) respectively; for patients with microcarcinoma was 84.54% (82/97), 100% (140/140), 0 (0/82), 15.46% (15/97), 100% (82/82), and 90.32% (140/155), respectively. ③ The value of SLNB to predict the presence of additional positive lymph nodes (APLN). The sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of SLNB to predict the APLN for all patients was 81.48% (132/162), 76.73% (188/245), 23.27% (57/245), 18.52% (30/162), 69.84% (132/189) and 86.24% (188/218), respectively; for patients with microcarcinoma was 73.68% (42/57), 77.78% (140/180), 22.22% (40/180), 26.32% (15/57), 51.22% (42/82) and 90.32% (140/155) respectively. ④ The value of positive sentinel lymph node ratio (PSLNR) to predict the presence of the APLN. The sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of PSLNR to predict the APLN for all patients was 71.97%, 78.95%, 21.05%, 28.03%, 88.79%, and 54.88% respectively, and the cutoff for PSLNR was 0.345 2. For patients with microcarcinoma, the sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of PSLNR to predict the APLN was 83.33%, 67.50%, 32.50%, 16.67%, 72.92%, and 79.41% respectively, and the cutoff for PSLNR was 0.291 7. Conclusion There is an important predicted value of SLNB for CCLN dissection in the patients suffered from differentiated thyroid carcinoma, and the PSLNR is a reliable basis for CCLN dissection.
ObjectiveTo identify the risk factors of central lymph nodal (CLN) metastasis in papillary thyroid carcinoma (PTC) and indicate central neck dissection. MethodsFifty cases were analyzed retrospectively. The BRAFV600E gene mutation was analyzed by sequencing and expression of VEGF-C was analyzed by using immunohistochemically. The clinicopathologic and molecular marker factors relating to CLN metastasis were analyzed. ResultsThe BRAFV600E gene mutation was found in 30 of 50 (60.0%) patients of PTC. Univariate analysis showed that BRAFV600E gene mutation of PTC patients was significantly correlated with high expression of VEGF-C (87.5% vs. 34.6%,P=0.000), not with clinicopathologic factors. High expression of VEGF-C was significantly correlated with CLN metastasis in PTC (87.5% vs. 57.7%, P=0.019). Multivariate analysis showed that invasion of the surrounding tissues (P=0.009,OR=9.082,95% CI:1.748-47.185) and the high expression of VEGF-C (P=0.009,OR=9.082,95% CI:1.748-47.185) were independent risk factors for the presence of CLN metastases. Conclusions①The BRAFV600E gene mutation for PTC patients is significantly correlated with high expression of VEGF-C, not with CLN metastasis in PTC. ②High expression of VEGF-C is significantly correlated with CLN metastasis in PTC. ③Tumor extrathyroidal extension, especially invasion of the surrounding tissues is significantly correlated with CLN metastasis in PTC.
ObjectiveTo investigate the role of intraoperative frozen section pathology in central lymph node metastasis of papillary thyroid microcarcinoma (PTMC), and to analyze the risk factors of central lymph node metastasis.MethodsClinical data of 481 patients diagnosed with PTMC from January 2015 to June 2019 in our hospital were included. The consistency of frozen pathological results of intraoperative prelaryngeal lymph nodes, pretracheal lymph nodes, and paratracheal lymph nodes with postoperative paraffin pathological results, as well as the relationship between the numbers of intraoperative lymph nodes sent for examination and postoperative pathological results were analyzed. Then the Kappa value were calculated respectively. Furthermore, univariate and multivariate analysis were used to analyze the factors affecting central lymph node metastasis.ResultsCentral lymph node metastasis was found in 207 patients with PTMC (43.0%). Of the 207 patients, 192 patients were examined by frozen section, with 139 patients had positive results. The Kappa value of prelaryngeal lymph nodes, paratracheal lymph nodes, pretracheal lymph nodes, and central lymph nodes were 0.300, 0.643, 0.560, and 0.755, respectively (P<0.001). Simultaneous intraoperative examination of three anatomic lymph nodes in the central region has a high accuracy in evaluating whether there was lymph node metastasis. The consistency test between intraoperative frozen and postoperative paraffin pathological results showed that when the number of lymph nodes was less than 5, the Kappa value was 0.690 (P<0.001), and when more than or equal to 5, the Kappa value was 0.816 (P<0.001). The results of logistic regression showed that, maximum value of tumor diameter, tumor number, and thyroid capsule involvement were risk factors for central region lymph node metastasis in PTMC (P<0.05).ConclusionsCentral region lymph node metastasis in PTMC was common. Prelaryngeal lymph nodes, pretracheal lymph nodes, and paratracheal lymph nodes should be selected for frozen pathological examination during the operation, which could effectively indicate whether the central lymph nodes were involved. And combined with the risk factors of lymph node metastasis, such as maximum value of tumor diameter, number of tumors, and thyroid capsule involvement, a more accurate individualized operation plan can be designed for patients.
Objective To analyze the clinical and pathological factors related to the metastasis of contralateral central lymph nodes (Cont-CLNs) in unilateral near isthmus papillary thyroid carcinoma (PTC), and to establish a prediction model of lymph node metastasis, so as to provide reference for the scope of lymph node dissection. Methods A total of 381 unilateral PTC patients from February 2012 to June 2022 were collected in our hospital, and according to the location of the cancer, they were divided into the isthmus group (n=152) and the unilateral glandular lobe group (n=229) , and the correlation analysis was performed on whether there was Cont-CLNs metastasis. One hundred and fifty-two patients in the unilateral isthmus PTC group were further divided into metastatic and non metastatic groups based on whether Cont-CLNs metastasis occurred. Univariate analysis was used to analyze the relationship between gender, age, distribution of glandular lobe, tumor size, tumor location, pathological subtype, capsule invasion, thyroid stimulating hormone (TSH) level, combine Hashimoto’s thyroiditis (HT), ipsilateral central lymph nodes（Ipsi-CLNs) metastasis and Cont-CLNs metastasis. According to the univariate analysis results of this study and the possible high-risk factors of contralateral central lymph node metastasis of unilateral thyroid papillary carcinoma in other literatures, they were included in logistic multivariate analysis to obtain independent risk factors and establish a prediction model. Results The incidence of Cont-CLNs metastasis in unilateral isthmus PTC patients was higher than that in nilateral glandular lobe group (24.3% vs. 14.4%, χ²=6.009, P=0.014). Univariate analysis showed that Cont-CLNs metastasis in patients with unilateral near isthmus PTC was correlated with age (P=0.02), tumor size (P＜0.01), capsule invasion (P＜0.01) and Ipsi-CLNs metastasis (P＜0.01), but not with gender, distribution of glandular lobe, tumor location, pathological subtype, TSH level and whether to merge HT (P＞0.05). Further logistic multivariate analysis suggested that capsule invasion and Ipsi-CLNs metastasis were independent risk factors for Cont-CLNs metastasis in patients with unilateral near isthmus PTC. Moreover, the above logistic multifactor prediction model is proved to be effective by the test of goodness of fit by Hosmer and Lemeshow. Conclusions Capsule invasion and Ipsi CLNs metastasis are high risk factors for Cont-CLNS metastasis in patients with unilateral near isthmus PTC. It is suggested that such patients should be cleaned up with prophylactic Cont-CLNs while cleaning up Ipsi-CLNs.