title: Macroscopic lymph-node involvement and neck dissection predict lymph-node recurrence in papillary thyroid carcinoma.
abstract: OBJECTIVE
  Whether 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.
  
  
  METHODS
  Overall 545 patients without distant metastases prior to surgery and main tumour > or =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.
  
  
  RESULTS
  Macroscopic 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.
  
  
  CONCLUSIONS
  Patients with macroscopic, but not microscopic, lymph-node involvement have a major LNR risk and need an optimal LND at primary surgery.
authors: Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, 3 Avenue Général Harris, BP 5026, F-14076 Caen Cedex 05, France. s.bardet@baclesse.fr
authors: Stéphane
authors: S
authors: Bardet
authors: Elodie
authors: E
authors: Malville
authors: Jean-Pierre
authors: JP
authors: Rame
authors: Emmanuel
authors: E
authors: Babin
authors: Guy
authors: G
authors: Samama
authors: Dominique
authors: D
authors: De Raucourt
authors: Jean-Jacques
authors: JJ
authors: Michels
authors: Yves
authors: Y
authors: Reznik
authors: Michel
authors: M
authors: Henry-Amar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002291:Carcinoma, Papillary / Q000175:diagnosis / Q000473:pathology*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000009:adverse effects; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000473:pathology*