title: Predictive factors for lateral occult lymph node metastasis in papillary thyroid carcinoma.
abstract: Management of lateral no necks in papillary thyroid carcinoma (PTC) is very controversial. The aim of this study was to find predictive factors of lateral neck involvement in N0 PTC to help the clinician in his decision to treat the lateral compartment. We retrospectively analysed 173 patients who underwent thyroidectomy and lateral prophylactic neck dissection for PTC >10 mm. Predictive factors for occult lateral lymph node metastasis including sex, age, tumour size, multifocality and bilaterality, tumour extracapsular spread, vascular invasion and presence of a tumour capsule were examined by multivariate analysis. There were three independent predictive factors for occult lateral lymph node metastases in multivariate analysis: tumour extracapsular spread (p < 0.0001), vascular invasion (p < 0.001) and age <45 years (p < 0.027). When none of these factors was present, the risk of occult metastases was <5 %. The risk increased up to 56 % when at least two of these factors were present. These findings suggest that, in patients older than 45 years with neither tumour extracapsular spread nor vascular invasion on histopathological examination, occult lymph node metastases are very uncommon. In that case further discussion regarding the risks and benefits of lateral nodal dissection may be warranted.
authors.affiliation: Department of Head and Neck Surgery, Rennes University Hospital, 2 rue Henri le Guillou, 35000 Rennes, France. vtromps@yahoo.fr
authors.forename: Vincent
authors.initials: V
authors.lastname: Patron
authors.forename: Martin
authors.initials: M
authors.lastname: Hitier
authors.forename: Cécile
authors.initials: C
authors.lastname: Bedfert
authors.forename: Alexandre
authors.initials: A
authors.lastname: Métreau
authors.forename: Audrey
authors.initials: A
authors.lastname: Dugué
authors.forename: Franck
authors.initials: F
authors.lastname: Jegoux
mesh_terms: D000328:Adult; D017677:Age Distribution; D002291:Carcinoma, Papillary / Q000556:secondary* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D037981:Neck Dissection; D012189:Retrospective Studies; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy