title: Predictive Factors of Superior Mediastinal Nodal Metastasis from Papillary Thyroid Carcinoma--A Prospective Observational Study.
abstract: OBJECTIVE
  The purpose of this study was to demonstrate the incidence rates and predictive factors of superior mediastinal lymph node (SMLN) metastasis in PTC (papillary thyroid carcinoma) patients.
  
  
  METHODS
  A prospective observational study was performed between January 2009 and January 2011. PTC patients who had tumors with a maximal diameter greater than 1 cm and clinically negative SMLNs were included in this study. Finally, a total of 217 patients who underwent total thyroidectomy with central compartment neck dissection (CND) and elective superior mediastinal lymph node dissection (SMLND), with or without modified radical neck dissection (MRND) and revisional CND, were included.
  
  
  RESULTS
  Occult SMLN metastasis was present in 15.7% (34/217). Cytological classifications of tumor, BRAFV600E mutation, Tumor size, T-stage, perithyroidal extension, lymphovascular invasion, multifocality, and paratracheal pN(+) were not predictive of SMLN metastasis (P > .05), while revision surgery, pretracheal pN(+), and multiple lateral pN(+) were associated with SMLN metastasis. There were no major complications related to SMLND. Transient and permanent hypoparathyroidism was observed in 69 cases (31.8%) and 8 cases (3.6%), respectively.
  
  
  CONCLUSIONS
  Despite clinically negative SMLN in preoperative evaluation, SMLN metastasis can be predicted for patients with a PTC tumor size larger than 1 cm, pretracheal LN metastasis, multiple lateral metastasis, and revisional surgery.
authors: Department of Otorhinolaryngology-Head and Neck Surgery, Gachon University, Graduate School of Medicine, Gil Medical Center, Incheon, Korea.
authors: Joo Hyun
authors: JH
authors: Woo
authors: Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University School of Medicine, Bucheon Hospital, Bucheon, Korea.
authors: Ki Nam
authors: KN
authors: Park
authors: Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University School of Medicine, Bucheon Hospital, Bucheon, Korea.
authors: Jae Yong
authors: JY
authors: Lee
authors: Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University School of Medicine, Bucheon Hospital, Bucheon, Korea.
authors: Seung Won
authors: SW
authors: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D002291:Carcinoma, Papillary; D002648:Child; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D037981:Neck Dissection / Q000009:adverse effects; D011379:Prognosis; D011446:Prospective Studies; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D047368:Tumor Burden; D055815:Young Adult