Lymph Node Metastasis from 259 Papillary Thyroid Microcarcinomas: Frequency, Pattern of Occurrence and Recurrence, and Optimal Strategy for Neck Dissection

Nobuyuki Wada, Quan Yang Duh, Kiminori Sugino, Hiroyuki Iwasaki, Kaori Kameyama, Takashi Mimura, Koichi Ito, Hiroshi Takami, Yoshinori Takanashi

Research output: Contribution to journalArticle

532 Citations (Scopus)

Abstract

Objective: To determine the frequency and pattern of lymph node metastasis (LNM) from papillary thyroid microcarcinoma (PTMC) and the results of node dissection, and to establish the optimal strategy for neck dissection in these patients. Summary Background Data: Most PTMCs carry a favorable prognosis, but a few present with palpable lymphadenopathy. Patients with LNM are at risk for nodal recurrence, although they do not have higher mortality. The frequency and pattern of LNM from PTMC and the results of node dissection are not well established. Methods: The frequency and pattern of LNM from 259 PTMCs were analyzed according to the size and location of the primary tumor. Of the 259, 24 with palpable nodes underwent therapeutic node dissection and the other 235 patients without palpable nodes underwent prophylactic node dissection. The authors compared the results of node dissection between the therapeutic group and the prophylactic group, and between PTMCs 5 mm or smaller and PTMCs larger than 5 mm. The authors also compared nodal recurrence between the prophylactic group and a no-lymph-node-dissection group (155 PTMCs). Results: Overall, 64.1% (166/259) and 44.5% (93/209) had node involvement of the central and ipsilateral lateral compartment, respectively. Pretracheal (43.2%), ipsilateral central (36.3%), and ipsilateral mid-lower (37.8%) jugular were more commonly involved. LNM was more frequent in the therapeutic group than in the prophylactic group (95.8% vs. 60.9% for central compartment, 83.3% vs. 39.5% for ipsilateral lateral compartment). Nodal recurrence was more common in the therapeutic group than in the prophylactic group (16.7% vs. 0.43%), but did not differ between the prophylactic group and the no-dissection group (0.43% vs. 0.65%). The tumor size did not influence nodal recurrence. Nodal recurrence preferentially occurred in ipsilateral mid-lower jugular nodes. Conclusions: Patients who have PTMC presenting with palpable lymphadenopathy should have therapeutic node dissection. Prophylactic node dissection is not beneficial in those without palpable lymphadenopathy.

Original languageEnglish
Pages (from-to)399-407
Number of pages9
JournalAnnals of Surgery
Volume237
Issue number3
DOIs
Publication statusPublished - 2003 Mar

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Neck Dissection
Dissection
Thyroid Gland
Lymph Nodes
Neoplasm Metastasis
Recurrence
Neck
Therapeutics
Lymph Node Excision
Neoplasms
Mortality

ASJC Scopus subject areas

  • Surgery

Cite this

Lymph Node Metastasis from 259 Papillary Thyroid Microcarcinomas : Frequency, Pattern of Occurrence and Recurrence, and Optimal Strategy for Neck Dissection. / Wada, Nobuyuki; Duh, Quan Yang; Sugino, Kiminori; Iwasaki, Hiroyuki; Kameyama, Kaori; Mimura, Takashi; Ito, Koichi; Takami, Hiroshi; Takanashi, Yoshinori.

In: Annals of Surgery, Vol. 237, No. 3, 03.2003, p. 399-407.

Research output: Contribution to journalArticle

Wada, Nobuyuki ; Duh, Quan Yang ; Sugino, Kiminori ; Iwasaki, Hiroyuki ; Kameyama, Kaori ; Mimura, Takashi ; Ito, Koichi ; Takami, Hiroshi ; Takanashi, Yoshinori. / Lymph Node Metastasis from 259 Papillary Thyroid Microcarcinomas : Frequency, Pattern of Occurrence and Recurrence, and Optimal Strategy for Neck Dissection. In: Annals of Surgery. 2003 ; Vol. 237, No. 3. pp. 399-407.
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title = "Lymph Node Metastasis from 259 Papillary Thyroid Microcarcinomas: Frequency, Pattern of Occurrence and Recurrence, and Optimal Strategy for Neck Dissection",
abstract = "Objective: To determine the frequency and pattern of lymph node metastasis (LNM) from papillary thyroid microcarcinoma (PTMC) and the results of node dissection, and to establish the optimal strategy for neck dissection in these patients. Summary Background Data: Most PTMCs carry a favorable prognosis, but a few present with palpable lymphadenopathy. Patients with LNM are at risk for nodal recurrence, although they do not have higher mortality. The frequency and pattern of LNM from PTMC and the results of node dissection are not well established. Methods: The frequency and pattern of LNM from 259 PTMCs were analyzed according to the size and location of the primary tumor. Of the 259, 24 with palpable nodes underwent therapeutic node dissection and the other 235 patients without palpable nodes underwent prophylactic node dissection. The authors compared the results of node dissection between the therapeutic group and the prophylactic group, and between PTMCs 5 mm or smaller and PTMCs larger than 5 mm. The authors also compared nodal recurrence between the prophylactic group and a no-lymph-node-dissection group (155 PTMCs). Results: Overall, 64.1{\%} (166/259) and 44.5{\%} (93/209) had node involvement of the central and ipsilateral lateral compartment, respectively. Pretracheal (43.2{\%}), ipsilateral central (36.3{\%}), and ipsilateral mid-lower (37.8{\%}) jugular were more commonly involved. LNM was more frequent in the therapeutic group than in the prophylactic group (95.8{\%} vs. 60.9{\%} for central compartment, 83.3{\%} vs. 39.5{\%} for ipsilateral lateral compartment). Nodal recurrence was more common in the therapeutic group than in the prophylactic group (16.7{\%} vs. 0.43{\%}), but did not differ between the prophylactic group and the no-dissection group (0.43{\%} vs. 0.65{\%}). The tumor size did not influence nodal recurrence. Nodal recurrence preferentially occurred in ipsilateral mid-lower jugular nodes. Conclusions: Patients who have PTMC presenting with palpable lymphadenopathy should have therapeutic node dissection. Prophylactic node dissection is not beneficial in those without palpable lymphadenopathy.",
author = "Nobuyuki Wada and Duh, {Quan Yang} and Kiminori Sugino and Hiroyuki Iwasaki and Kaori Kameyama and Takashi Mimura and Koichi Ito and Hiroshi Takami and Yoshinori Takanashi",
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T1 - Lymph Node Metastasis from 259 Papillary Thyroid Microcarcinomas

T2 - Frequency, Pattern of Occurrence and Recurrence, and Optimal Strategy for Neck Dissection

AU - Wada, Nobuyuki

AU - Duh, Quan Yang

AU - Sugino, Kiminori

AU - Iwasaki, Hiroyuki

AU - Kameyama, Kaori

AU - Mimura, Takashi

AU - Ito, Koichi

AU - Takami, Hiroshi

AU - Takanashi, Yoshinori

PY - 2003/3

Y1 - 2003/3

N2 - Objective: To determine the frequency and pattern of lymph node metastasis (LNM) from papillary thyroid microcarcinoma (PTMC) and the results of node dissection, and to establish the optimal strategy for neck dissection in these patients. Summary Background Data: Most PTMCs carry a favorable prognosis, but a few present with palpable lymphadenopathy. Patients with LNM are at risk for nodal recurrence, although they do not have higher mortality. The frequency and pattern of LNM from PTMC and the results of node dissection are not well established. Methods: The frequency and pattern of LNM from 259 PTMCs were analyzed according to the size and location of the primary tumor. Of the 259, 24 with palpable nodes underwent therapeutic node dissection and the other 235 patients without palpable nodes underwent prophylactic node dissection. The authors compared the results of node dissection between the therapeutic group and the prophylactic group, and between PTMCs 5 mm or smaller and PTMCs larger than 5 mm. The authors also compared nodal recurrence between the prophylactic group and a no-lymph-node-dissection group (155 PTMCs). Results: Overall, 64.1% (166/259) and 44.5% (93/209) had node involvement of the central and ipsilateral lateral compartment, respectively. Pretracheal (43.2%), ipsilateral central (36.3%), and ipsilateral mid-lower (37.8%) jugular were more commonly involved. LNM was more frequent in the therapeutic group than in the prophylactic group (95.8% vs. 60.9% for central compartment, 83.3% vs. 39.5% for ipsilateral lateral compartment). Nodal recurrence was more common in the therapeutic group than in the prophylactic group (16.7% vs. 0.43%), but did not differ between the prophylactic group and the no-dissection group (0.43% vs. 0.65%). The tumor size did not influence nodal recurrence. Nodal recurrence preferentially occurred in ipsilateral mid-lower jugular nodes. Conclusions: Patients who have PTMC presenting with palpable lymphadenopathy should have therapeutic node dissection. Prophylactic node dissection is not beneficial in those without palpable lymphadenopathy.

AB - Objective: To determine the frequency and pattern of lymph node metastasis (LNM) from papillary thyroid microcarcinoma (PTMC) and the results of node dissection, and to establish the optimal strategy for neck dissection in these patients. Summary Background Data: Most PTMCs carry a favorable prognosis, but a few present with palpable lymphadenopathy. Patients with LNM are at risk for nodal recurrence, although they do not have higher mortality. The frequency and pattern of LNM from PTMC and the results of node dissection are not well established. Methods: The frequency and pattern of LNM from 259 PTMCs were analyzed according to the size and location of the primary tumor. Of the 259, 24 with palpable nodes underwent therapeutic node dissection and the other 235 patients without palpable nodes underwent prophylactic node dissection. The authors compared the results of node dissection between the therapeutic group and the prophylactic group, and between PTMCs 5 mm or smaller and PTMCs larger than 5 mm. The authors also compared nodal recurrence between the prophylactic group and a no-lymph-node-dissection group (155 PTMCs). Results: Overall, 64.1% (166/259) and 44.5% (93/209) had node involvement of the central and ipsilateral lateral compartment, respectively. Pretracheal (43.2%), ipsilateral central (36.3%), and ipsilateral mid-lower (37.8%) jugular were more commonly involved. LNM was more frequent in the therapeutic group than in the prophylactic group (95.8% vs. 60.9% for central compartment, 83.3% vs. 39.5% for ipsilateral lateral compartment). Nodal recurrence was more common in the therapeutic group than in the prophylactic group (16.7% vs. 0.43%), but did not differ between the prophylactic group and the no-dissection group (0.43% vs. 0.65%). The tumor size did not influence nodal recurrence. Nodal recurrence preferentially occurred in ipsilateral mid-lower jugular nodes. Conclusions: Patients who have PTMC presenting with palpable lymphadenopathy should have therapeutic node dissection. Prophylactic node dissection is not beneficial in those without palpable lymphadenopathy.

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