Central nodal metastases in papillary thyroid carcinoma based on tumor histologic type and focality.
OBJECTIVE
To determine the risk of nodal metastases to the central compartment from differentiated papillary thyroid carcinoma (PTC) relative to known prognostic variables.


METHODS
A 7-year single-institutional retrospective review.


METHODS
Tertiary academic center.


METHODS
A total of 115 patients undergoing central neck dissection (CND) for PTC or follicular variant PTC (FVPTC).


METHODS
Number, location, and positivity of lymph nodes for malignant disease in the central compartment based on patient age, sex, extrathyroidal extension, and primary tumor size, histologic type, and focality.


RESULTS
Eighty-seven percent of patients had PTC, and 13% had FVPTC. Bilateral (64%) or ipsilateral (36%) CND was performed in patients with PTC. Patients with FVPTC underwent only ipsilateral CND. There was no significant difference in the number of lymph nodes retrieved based on patient age or sex, histologic type of the primary tumor, size or focality, or surgeon or pathologist. Seventy-eight percent of patients with PTC had malignant lymph nodes in the ipsilateral (75%) or bilateral/contralateral (69%) central compartment. Ipsilateral nodal metastases directly correlated with tumor multifocality (r = 0.93; P = .001) and size (r = 0.89; P = .001). Bilateral nodal metastases directly correlated with tumor multifocality (r = 0.92; P = .001) but was independent of size (r = 0.56; P = .001). No malignant lymph nodes were identified in the central compartment of FVPTC.


CONCLUSIONS
Malignant central nodal metastases occur with high frequency in PTC but not in FVPTC. The risk of metastases correlated with the size and multifocality of the primary tumor. Additional studies are warranted to determine the extent of CND in patients with and without known multifocal disease and to determine the role of CND in patients with FVPTC.
Salter
Kelli D
KD
Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA.
Andersen
Peter E
PE
Cohen
James I
JI
Schuff
Kathyrn G
KG
Lester
Linda
L
Shindo
Maisie L
ML
Sauer
David
D
Gross
Neil D
ND
D000046:Academic Medical Centers; D001707:Biopsy, Needle; D002291:Carcinoma, Papillary / Q000401:mortality / Q000473:pathology* / Q000556:secondary* / Q000601:surgery; D018265:Carcinoma, Papillary, Follicular / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D037981:Neck Dissection / Q000379:methods; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome