scholarly journals Ultrasonography for the Prediction of High-Volume Lymph Node Metastases in Papillary Thyroid Carcinoma: Should Surgeons Believe Ultrasound Results?

2020 ◽  
Vol 44 (12) ◽  
pp. 4142-4148
Author(s):  
Chunhao Liu ◽  
Lei Zhang ◽  
Yuewu Liu ◽  
Yu Xia ◽  
Yue Cao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lymph Node ◽  
Predictive Value ◽  
High Volume ◽  
Lymph Node Involvement ◽  
Tumor Diameter ◽  
Papillary Thyroid ◽  
Node Involvement ◽  
Node Metastases ◽  
Male Sex

Abstract Background Lymph node metastasis (LNM) often occurs in papillary thyroid carcinoma (PTC); the efficacy of ultrasound for predicting high-volume lymph node metastases (LNMs) in patients with PTC remains unexplored. Methods The medical records of 2073 consecutive PTC patients were reviewed. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated to evaluate the efficacy of ultrasound. Risk factors for LNM/high-volume LNMs and lymph node involvement on ultrasound (usLNM) were identified by univariate and multivariate analyses. Results Of all the patients, 936 (45.2%) patients had LNMs, and 254 (12.3%) patients had high-volume LNMs. The sensitivity of ultrasound for detecting LNM/high-volume LNMs was 27.9% and 63.8%, respectively; the specificity was 93.1% and 90.3%, respectively. The NPV for ultrasound in detecting high-volume LNMs was 94.7%. In multivariate analysis, male sex (OR = 2.108, p < 0.001), tumor diameter > 1.0 cm (OR = 2.304, p < 0.001) and usLNM (+) (OR = 12.553, p < 0.001) were independent clinical risk factors for high-volume LNMs. Tumor diameter > 1 cm (OR = 3.036, p < 0.001) and male sex (OR = 1.642, p < 0.001) were independent clinical risk factors for usLNM; a skilled sonographer (OR = 1.121, p = 0.358) was not significantly associated with usLNM. Conclusions Lymph node involvement found by ultrasound has great predictive value for high-volume LNMs; the NPV is very high for patients without lymph node involvement on ultrasound. The ultrasound results do not appear to be influenced by the experience of the sonographer.

scholarly journals Macroscopic lymph-node involvement and neck dissection predict lymph-node recurrence in papillary thyroid carcinoma.

2008 ◽  
Vol 158 (4) ◽  
pp. 551-560 ◽  
Author(s):  
Stéphane Bardet ◽  
Elodie Malville ◽  
Jean-Pierre Rame ◽  
Emmanuel Babin ◽  
Guy Samama ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
Lymph Node Involvement ◽  
Cumulative Probability ◽  
Papillary Thyroid ◽  
Node Involvement ◽  
Node Metastases ◽  
Group 3 ◽  
Group 2

ObjectiveWhether lymph-node dissection (LND) influences the lymph-node recurrence (LNR) risk in patients with papillary thyroid cancer remains controversial. The prognostic impact of macroscopic and microscopic lymph-node involvement at diagnosis is also an unresolved issue. A retrospective study was conducted to assess the influence of various LND procedures and to search for LNR risk factors.MethodsOverall 545 patients without distant metastases prior to surgery and main tumour ≥10 mm were included. A total thyroidectomy was performed in all patients with either no LND (Group 1,n=161), bilateral LND of the central and lateral compartments (Group 2,n=181) or all other dissection modalities (Group 3,n=203). Post-operative radioiodine was given to 496 (91%) patients. The 10-year cumulative probability of LNR was assessed and a prognostic study using multivariate analysis was performed.ResultsMacroscopic lymph-node metastases were present in 118 patients, 57 diagnosed before surgery and 61 only at surgery (including 81% in the central compartment). Overall, the 10-year cumulative probability of LNR was 7%. Macroscopic lymph-node metastases (P=0.001), extra-thyroidal invasion (P=0.017) and male gender (P=0.05) were independent risk factors, while bilateral LND of the central and lateral compartments was protective (P=0.028). In patients with macroscopic lymph-node metastases, the 10-year probability was lower in Group 2 than in Group 3 (10% vs 30%,P<0.01). In patients without macroscopic lymph-node metastases (n=427), no significant differences were observed between the three LND groups.ConclusionsPatients with macroscopic, but not microscopic, lymph-node involvement have a major LNR risk and need an optimal LND at primary surgery.

scholarly journals Risk factors for high-volume lymph node metastases in cN0 papillary thyroid microcarcinoma

Gland Surgery ◽  
2019 ◽  
Vol 8 (5) ◽  
pp. 550-556 ◽  
Author(s):  
Chunhao Liu ◽  
Yuewu Liu ◽  
Lei Zhang ◽  
Yunwei Dong ◽  
Shenbao Hu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
High Volume ◽  
Papillary Thyroid Microcarcinoma ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma ◽  
Node Metastases

scholarly journals Analysis of risk factors for cervical lymph node metastasis of papillary thyroid microcarcinoma: a study of 268 patients

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jian-hua Gu ◽  
Yan-na Zhao ◽  
Rong-li Xie ◽  
Wen-juan Xu ◽  
Da-li You ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lymph Node ◽  
Multivariate Regression ◽  
Cervical Lymph Node ◽  
Cervical Lymph Node Metastasis ◽  
Papillary Thyroid Microcarcinoma ◽  
Tumor Diameter ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma ◽  
Male Sex

Abstract Background To investigate the risk factors of cervical lymph node (LN) metastasis in papillary thyroid microcarcinoma (PTMC) patients. Methods We retrospectively analyzed the clinicopathologic data of all patients who received standard lobectomy for PTMC at our institution between October 2017 and January 2019. Central LNs were dissected in all patients. Lateral LNs were dissected if metastasis to the lateral LNs was suggested based on pre-op fine-needle aspiration biopsy. The relationship between variables available prior to surgery and cervical LN metastasis was examined using multivariate regression. Results Post-op pathologic examination revealed cervical LN metastasis in 79 (29.5%) patients. Seventy subjects had metastasis only to central LNs, and 4 (1.5%) patients had metastasis only to lateral LNs. Five patients had metastasis to both central and lateral LNs. In comparison to patients without cervical LN metastasis, those with LN metastasis were significantly younger (40.63 ± 13.07 vs. 44.52 ± 12.23 years; P = 0.021) and had significantly larger tumor diameter on pathology (6.7 ± 2.2 vs. 5.9 ± 2.4 mm; P = 0.010). Multivariate regression analysis identified the following independent risks for cervical LN metastasis: male sex (OR 2.362, 95%CI 1.261~4.425; P = 0.007), age (OR 0.977, 95%CI 0.956~0.999; P = 0.042) and ultrasound tumor diameter at > 5 mm (OR 3.172, 95%CI 1.389~7.240; P = 0.006). Conclusion Cervical LN metastasis occurs in a non-insignificant proportion of PTMC patients. Independent risks included male sex, younger age and larger tumor diameter on ultrasound.

Specificity of radiographic lymphadenopathy for lymph node metastasis in renal cell carcnioma.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 442-442
Author(s):  
Matthew Mossanen ◽  
Manjiri Dighe ◽  
Bryan Wilson ◽  
Daniel W. Lin ◽  
Jonathan L. Wright ◽  
...  
Keyword(s):  
Lymph Node ◽  
Metastatic Disease ◽  
Lymph Node Metastases ◽  
Predictive Value ◽  
Renal Cell ◽  
Multivariate Logistic Regression Analysis ◽  
Lymph Node Involvement ◽  
Preoperative Imaging ◽  
Node Involvement ◽  
Node Metastases

442 Background: Approximately 30% of patients with renal cell carcinoma (RCC) will have metastatic disease at the time of diagnosis. Patients without preoperative lymphadenopathy (LAD) radiographically rarely have positive nodes at the time of nephrectomy. We sought to evaluate the specificity of radiographic LAD for lymph node metastases in patients with and without clinical metastatic RCC. Methods: We retrospectively reviewed all nephrectomies performed at our institution from 2003-2013. We identified patients with clinical stage classification T2-T3 (cT2-T3) RCC and stratified patients by clinical N and M classification. Lymphadenectomy was performed at surgeon discretion. Performance statistics for preoperative imaging for pathologic lymph node metastases and multivariable logistic regressions models to identify patient characteristics associated with lymph node metastases were generated. Results: A total of 223 patients were identified. Of these, 85 (38%) had clinical evidence of metastatic disease while 138 (62%) did not. In patients with clinical metastatic disease, LND was performed in 68%; of those without clinical metastatic disease, LND was performed in 48%. Radiographic LAD for those with clinical metastatic disease (26/85 patients, 31%) had sensitivity of 94%, specificity of 49%, positive predictive value (PPV) of 43%, and negative predictive value (NPV) of 95% for pathologically confirmed lymph node involvement. Radiographic LAD for patients without clinical metastatic disease (37/138 patients, 27%) had sensitivity of 90%, specificity of 52%, PPV of 25%, and NPV of 96% for pathologically confirmed lymph node involvement. On multivariate logistic regression analysis (adjusted for age, gender, smoking status, obesity, non-clear cell histology, and grade) having clinical metastatic disease was significantly associated with pathologic node positivity (RR = 3.37, 95% CI 1.19 – 20.6). Conclusions: Radiographic lymphadenopathy is a nonspecific finding in patients with RCC and LND is not routinely performed at our institution. However, in the setting of clinical metastatic disease, radiographic LAD is more likely to represent pathological lymph node metastases.

scholarly journals Initial Presentation and Late Results of Treatment of Post-Chernobyl Papillary Thyroid Carcinoma in Children and Adolescents of Belarus

2014 ◽  
Vol 99 (8) ◽  
pp. 2932-2941 ◽  
Author(s):  
Mikhail Fridman ◽  
Natallia Savva ◽  
Olga Krasko ◽  
Svetlana Mankovskaya ◽  
Daniel I. Branovan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lymph Node ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Children And Adolescents ◽  
Lymph Node Involvement ◽  
Papillary Thyroid ◽  
Free Survival ◽  
Node Involvement

Background: The aim of this population-based study was to evaluate the clinical and pathological characteristics and outcome of papillary thyroid carcinoma (PTC) that have arisen in the Belarusian childhood population exposed to the radioactive fallout from the Chernobyl accident within a long-term period. Patients and Methods: The long-term treatment results were investigated in 1078 children and adolescents (&lt;19 years old) with PTC who were surgically treated during the years 1990 through 2005. Results: Patients had high rates of metastatic PTC at presentation, with 73.8% of cases having lymph node involvement and 11.1% having distant spread. The most influential factor for lymph node metastases at initial treatment was lymphatic vessel invasion (P &lt; .0001) and for distant metastases, lateral lymph node involvement (P &lt; .0001). The overall survival was 96.9% ± 0.9% with a median follow-up of 16.21 years, and 20-year event-free survival and relapse-free survival were 87.8% ± 1.6% and 92.3% ± 0.9%, respectively. Patients had significantly lower probability of both loco-regional (P &lt; .001) and distant relapses (P = .005) after total thyroidectomy (TT) and radioactive iodine therapy (RAI). For loco-regional relapses after TT, only RAI influenced the prognosis significantly (P &lt; .001). For distant relapses after TT, the refusal to treat with RAI (hazard ratio [HR] = 9.26), vascular invasion (HR = 8.68), and age at presentation (HR = 6.13) were significant risk factors. For loco-regional relapses after non-TT, the principal risk factors were age less than 15 years old at presentation (HR = 5.34) and multifocal growth of tumor (HR = 5.19). For distant relapses after non-TT, the lateral neck metastases were the only unfavorable factor (HR = 9.26). Conclusion: The outcome of PTC both in children and in adolescents exposed to the post-Chernobyl radioiodine fallout was rather favorable. TT with RAI is recommended for minimizing loco-regional or distant relapses.

scholarly journals Papillary Thyroid Microcarcinomas: a 25 Years Retrospective, Institutional Study of 255 Cases

2016 ◽  
Vol 62 (1) ◽  
pp. 41-46 ◽  
Author(s):  
Ancuța Elena Zahan ◽  
Adela Nechifor Boilă ◽  
Ionela Pașcanu ◽  
Septimiu Voidăzan ◽  
Ramona Cătană ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Tumor Size ◽  
Lymph Node Involvement ◽  
Postoperative Management ◽  
Extrathyroidal Extension ◽  
Papillary Thyroid ◽  
Biological Potential ◽  
Node Involvement

AbstractBackground: Papillary thyroid microcarcinoma (PTMC) defines a group of papillary thyroid carcinomas, incidentally discovered, measuring 1 cm or less. The aim of our study was to evaluate the incidence and the pathological characteristics of PTMCs in our institution in the last 25 years, with special emphasis on the prognostic factors related to PTMCs. Material and methods: We performed a retrospective, cohort study on 255 PTMCs, registered in the Department of Pathology, Tîrgu-Mureş Emergency County Hospital between 1990 and 2014. Results: A significant increase in the incidence of PTMCs was observed in the 2004-2014 period, compared to 1990-2003 (7.6%, 229 PTMCs/3005 thyroid specimens vs. 1.2%, 23 PTMCs/1885 thyroid specimens). Conventional PTMCs accounted for most of PTMC cases (n=123 cases, 48.2%), followed by the follicular variant of PTC (n=117 cases, 45.9%). The increasing incidence of PTMCs was associated with a significant increase in the routine number of blocks sampled per case over the study period (R2 =0.72, p < 0.001). By means of the univariate and multivariate analysis, three risk factors were predictive for extrathyroidal extension in PTMCs: multifocality (Odds ratio [OR] 4.97, p-0.002), tumor size ≥ 5mm (OR 8.97, p-0.008) and lymph node involvement (OR 17.66 p<0.005). Conclusion: The incidence of PTMCs has revealed a significant increasing trend in our institution over the last 25 years. Multifocality, lymph node involvement and tumor size ≥ 5mm were found to be risk factors for extrathyroidal extension. These prognostic factors must be evaluated and clearly mentioned in the pathological report, to help a correct estimation of biological potential of the lesion and an appropriate postoperative management.

Histology as a Prognostic Factor in Early Gastric Cancer

1992 ◽  
Vol 78 (3) ◽  
pp. 181-184
Author(s):  
Massimo Ferrari ◽  
Enrico Ghislandi ◽  
Giuseppe Landonio ◽  
Margherita Majno ◽  
Tiziano Porretta ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Lymph Node ◽  
Prognostic Factor ◽  
Early Gastric Cancer ◽  
Lymph Node Involvement ◽  
Depth Of Invasion ◽  
Undifferentiated Histology ◽  
Node Involvement

Of 431 patients with gastric cancer observed in our Istitution, 23 (5.3 %) had early gastric cancer (EGC). Macroscopic presentation, histology, depth of invasion, and lymph node involvement were evaluated in all the cases. All patients underwent surgery and an intensive follow-up was performed. Five of the 23 patients progressed, and the risk factors were examined. Histology seemed to be the main prognostic factor in our study, since intestinal type of EGC was associated to a significantly better prognosis. Total gastrectomy is indicated in the proximal localization of EGC, and should perhaps be performed also in cases presenting undifferentiated histology.

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