Preoperative Prediction of Central Lymph Node Metastasis in Thyroid Papillary Microcarcinoma Using Clinicopathologic and Sonographic Features

• Published in: World journal of surgery Vol. 37; no. 2; pp. 385 - 391
• Main Authors: Kim, Kyung-Eun, Kim, Eun-Kyung, Yoon, Jung Hyun, Han, Kyung Hwa, Moon, Hee Jung, Kwak, Jin Young
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.02.2013; Springer‐Verlag; John Wiley & Sons, Inc
• Subjects: Abdominal Surgery; Adolescent; Adult; Aged; Aged, 80 and over; American Thyroid Association; Carcinoma, Papillary - diagnostic imaging; Carcinoma, Papillary - pathology; Carcinoma, Papillary - surgery; Cardiac Surgery; Decision Support Techniques; Female; General Surgery; Humans; Large Tumor Size; Logistic Models; Lymph Node Metastasis; Lymphatic Metastasis; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Neck Dissection; Neoplasm Staging; Odds Ratio; Papillary Thyroid Carcinoma; Preoperative Care; Retrospective Studies; Risk Factors; Surgery; Thoracic Surgery; Thyroid Cancer; Thyroid Neoplasms - diagnostic imaging; Thyroid Neoplasms - pathology; Thyroid Neoplasms - surgery; Thyroidectomy; Ultrasonography; Vascular Surgery; Young Adult; Papillary Thyroid Carcinoma; Large Tumor Size; American Thyroid Association; Lymph Node Metastasis; Thyroid Cancer
• ISSN: 0364-2313; 1432-2323; 1432-2323
• DOI: 10.1007/s00268-012-1826-3

Background The purpose of the present study was to evaluate the clinicopathologic factors and ultrasound (US) features predictive of central lymph node metastasis (LNM) in patients diagnosed with papillary thyroid microcarcinoma (PTMC). Methods From March 2008 to August 2008, the clinicopathologic features and preoperative US features of 483 patients who were diagnosed with conventional PTMC were included. Medical records, US features, and pathology reports of all patients were retrospectively reviewed. Univariate and multivariate analysis was performed to identify clinicopathological prognostic factors associated with central LNM. Odds ratios (OR) with relative 95 % confidence intervals (95 % CI) were calculated to determine the relevance of all potential predictors of central LNM. Results Among the 483 patients with PTMC, 139 (28.8 %) patients had central LNM. The OR of significant independent factors were 2.055 (95 % CI, 1.137–3.716), 2.075 (95 % CI, 1.27–3.39), 1.71 (95 % CI, 1.073–2.724), and 15.897 (95 % CI, 4.173–60.569), respectively, for bilaterality, larger tumor size (>5 mm), extracapsular invasion, and lateral LNM. No significant association was seen among the US features of PTMC with central LNM. Conclusions Central lymph node metastasis in patients with PTMC was significantly associated with various clinicopathological factors, including larger tumor size (>5 mm), bilaterality, extracapsular invasion, and lateral LNM. When these features are detected on preoperative US, selective central compartment dissection may be helpful in patients diagnosed with PTMC.