title: Papillary thyroid carcinoma located in the isthmus or upper third is associated with Delphian lymph node metastasis.
abstract: BACKGROUND
  Delphian lymph node (DLN) metastasis is a recognized indicator of further lymph node involvement in papillary thyroid carcinoma (PTC). The aim of this study was to evaluate the clinicopathological significance of and risk factors for DLN metastasis.
  
  
  METHODS
  The medical records of 1,436 patients who underwent primary thyroidectomy for classical PTC with a tumor size of 2 cm or less were reviewed. Of these, 370 patients from whom the DLN was harvested were enrolled. Metastasis in DLN was present in 46 patients and absent in 324 patients. Clinicopathological features were compared according to DLN metastasis.
  
  
  RESULTS
  In univariate analysis, DLN metastasis was associated with suspected lymph node metastasis on preoperative ultrasonography, tumor location in the isthmus or upper third of the thyroid, larger tumor size, extrathyroid extension, lymphovascular invasion, and further lymph node metastasis. Multivariable analysis revealed that DLN metastasis was associated with tumor location in the isthmus or upper third of the thyroid (odds ratio [OR] = 2.420; 95 % confidence interval [CI] 1.193-4.910) and further lymph node metastasis (OR = 4.746; 95 % CI 2.065-10.908).
  
  
  CONCLUSIONS
  DLN metastasis in PTC is associated with tumor location in the isthmus or upper third of the thyroid and unfavorable clinicopathological characteristics. Careful consideration and patient management are warranted when preoperative ultrasonography indicates that the tumor is located in the isthmus or upper third of the thyroid.
authors.affiliation: Department of Surgery, Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
authors.forename: Young Jun
authors.initials: YJ
authors.lastname: Chai
authors.forename: Su-Jin
authors.initials: SJ
authors.lastname: Kim
authors.forename: June Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Do Hoon
authors.initials: do H
authors.lastname: Koo
authors.forename: Kyu Eun
authors.initials: KE
authors.lastname: Lee
authors.forename: Yeo-Kyu
authors.initials: YK
authors.lastname: Youn
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001707:Biopsy, Needle; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D002291:Carcinoma, Papillary; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D016017:Odds Ratio; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D000077273:Thyroid Cancer, Papillary; D013961:Thyroid Gland / Q000473:pathology* / Q000601:surgery; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler