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Study to Evaluate the Pattern of Nodal Distribution in Papillary Thyroid Cancer

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Abstract

Among the thyroid cancers, papillary thyroid cancer (PTC) is the most common with lymphatic metastasis. It has the propensity to spread to the level II-VI lymph nodes in a predictable manner. We evaluated the pattern of nodal distribution at different levels of neck in papillary thyroid cancer in this Observational Prospective study. Total 41 patients of PTC (Papillary thyroid cancer) were included in the study. 36 out of them were diagnosed as PTC by FNAC and underwent total thyroidectomy and central neck dissection, while 5 patients were histologically confirmed cases of PTC on previous hemithyroidectomy and underwent completion thyroidectomy and central neck dissection .Patients with T3/T4 stage or N1 underwent lateral neck dissection also. Clinicopathological factors such as age, sex, tumor stage, nodal metastasis and extracapsular invasion, were evaluated.

Lymph node metastasis was noted in 21 patients (51.2%) and all these patients had central (level VI) lymph node involvement. Among 21 patients, pathological ipsilateral lateral neck metastasis was noted in 6 patients (28.57%) at level II, 10 patients (47.62%) at level III and 8 patients (38.10%) at level IV. Only 5 patients (23.81%) had metastasis at level V. Extracapsular invasion was observed in 10 (24.4%) patients.

We concluded that patients with PTC show higher rates of metastasis at central neck (level VI) and are not easily detected on clinical examination or by USG due to low sensitivity but are sensitive and specific for lateral neck nodes in late stages . Thus, ipsilateral selective neck dissection should be considered with total thyroidectomy and central neck dissection in presence of clinically or radiologically evident lateral lymph nodes (preoperatively) and in T3, T4 stage (late stages) tumors.

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Availability of Data and Material

Pro-forma of the data taken is filled for every patient and is available with the first author for review.

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References

  1. Jemal A, Siegel R, Xu J, Ward E (2010) Cancer statistics 2010. CA Cancer J Clin 60:277300

    Article  Google Scholar 

  2. Trivizki O, Amit M, Fliss DM, Gil Z (2013) Elective central compartment neck dissection in patients with papillary thyroid carcinoma recurrence. Laryngoscope 123:1564–1568

    Article  PubMed  Google Scholar 

  3. Davidson HC, Park BJ, Johnson JT (2008) Papillary thyroid cancer: controversies in the management of neck metastasis. Laryngoscope 118(12):2161–2165

    Article  PubMed  Google Scholar 

  4. White ML, Gauger PG, Doherty GM (2007) Central lymph node dissection in differentiated thyroid cancer. World J Surg 31:895–904

    Article  PubMed  Google Scholar 

  5. Pearce EN, Braverman LE (2004) Papillary thyroid microcarcinoma outcomes and implications for treatment. J Clin Endocrinol Metab 89:3710–3712

    Article  CAS  PubMed  Google Scholar 

  6. Giordano D, Frasoldati A, Kasperbauer JL, Gabrielli E, Pernice C, Zini M et al (2015) Lateral neck recurrence from papillary thyroid carcinoma: predictive factors and prognostic significance. Laryngoscope 125:2226–2231

    Article  PubMed  Google Scholar 

  7. Gosnell JE, Clark OH (2008) Surgical approaches to thyroid tumors. Endocrinol Metab Clin North Am 37:437–455

    Article  PubMed  Google Scholar 

  8. Moo TA, Fahey TJ 3 (2011) Lymph node dissection in papillary thyroid carcinoma. Semin Nucl Med 41:84–88

  9. Sakorafas GH, Sampanis D, Safioleas M (2010) Cervical lymph node dissection in papillary thyroid cancer: current trends, persisting controversies, and unclarified uncertainties. Surg Oncol 19:e57–70

    Article  PubMed  Google Scholar 

  10. Goyal N, Pakdaman M, Kamani D et al (2017) Mapping the distribution of nodal metastasis in papillary thyroid carcinoma: where exactly are the nodes? Laryngoscope 127:1959–1964

    Article  PubMed  Google Scholar 

  11. El-Foll HA, El-Sebaey HI, El-Kased AF, Hendawy A, Kamel MM (2015) Pattern and distribution of lymph node metastasis in papillary thyroid cancer. J Clin Exp Pathol 5:204

    Article  Google Scholar 

  12. Noguchi S, Noguchi A, Murakami N (1970) Papillary carcinoma of the thyroid. I. developing pattern of metastasis. Cancer 26:1053–1060

    Article  CAS  PubMed  Google Scholar 

  13. Machens A, Hinze R, Thomusch O, Dralle H (2002) Pattern of nodal metastasis for primary and reoperative thyroid cancer. World J Surg 26:22–28

    Article  PubMed  Google Scholar 

  14. Mirallié E, Visset J, Sagan C et al (1999) Localization of cervical node metastasis of papillary thyroid carcinoma. World J Surg 23:970–974

    Article  PubMed  Google Scholar 

  15. Carty SE, Cooper DS, Doherty GM et al (2009) Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid 19:1153–1158

    Article  PubMed  Google Scholar 

  16. Sivanandan R, Soo KC (2001) Pattern of cervical lymph node metastasis from papillary carcinoma of the thyroid. Br J Surg 88:1241–1244

    Article  CAS  PubMed  Google Scholar 

  17. Ito Y, Hirokawa M, Uruno T, Kihara M, Higashiyama T, Takamura Y, Miya A, Kobayashi K, Matsuzuka F, Miyauchi A Prevalence and biological behaviour of variants of papillary thyroid carcinoma: experience at a single institute.Pathology 2008Oct; 40(6):617–22

  18. Qubain SW, Nakano S, Baba M, Takao S, Aikou T (2002) Distribution of lymph node micrometastasis in pN0 well-differentiated thyroid carcinoma. Surgery 131(3):249–256

    Article  PubMed  Google Scholar 

  19. Costa S, Giugliano G, Santoro L et al (2009) Role of prophylactic central neck dissection in cN0 papillary thyroid cancer. Acta Otorhinolaryngol Ital 29:61–69

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Arora N, Turbendian HK, Kato MA et al (2009) Papillary thyroid carcinoma and microcarcinoma: is there a need to distinguish the two? Thyroidology 19:473–477

    Article  Google Scholar 

  21. Ito Y, Tomoda C, Uruno T et al (2006) Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid. World J Surg 30:91–99

    Article  PubMed  Google Scholar 

  22. Bonnet S, Hartl D, Leboulleux S et al (2009) Prophylactic lymph node dissection for papillary thyroid cancer less than 2 cm: implications for radioiodine treatment. J Clin Endocrinol Metab 94:1162–1167

    Article  CAS  PubMed  Google Scholar 

  23. Hughes DT, Doherty GM (2011) Central neck dissection for papillary thyroid cancer. Cancer Control 18:83–88

    Article  PubMed  Google Scholar 

  24. Yanir Y, Doweck I (2008) Regional metastasis in well-differentiated thyroid carcinoma: pattern of spread. Laryngoscope 118:433–436

    Article  PubMed  Google Scholar 

  25. Pingpank JF Jr, Sasson AR, Hanlon AL, Friedman CD, Ridge JA (2002) Tumor above the spinal accessory nerve in papillary thyroid cancer that involves lateral neck nodes: a common occurrence. Arch Otolaryngol Head Neck Surg 128:1275–1278

    Article  PubMed  Google Scholar 

  26. Kupferman ME, Wienstock YE, Santillan AA (2008) Predictors of level V metastasis in well-differentiated thyroid cancer. Head neck 30:1469–1474

    Article  PubMed  Google Scholar 

  27. Lee SH, Lee SS, Jin SM, Kim JH, Rho YS (2008) Predictive factors for central compartment lymph node metastasis in thyroid papillary microcarcinoma. Laryngoscope 118:659–662

    Article  PubMed  Google Scholar 

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Funding

No financial funding received. Patients were treated free of cost under ‘MNDY (Mukhyamantri Nishulk Dava Yojana) scheme’ sponsored by Government of Rajasthan.

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Authors and Affiliations

  1. Department of ENT, SMS Medical College and Hospital, Jaipur, Rajasthan, India

    Sunil Kumar Samdhani & Mahendra Singh Hada

  2. Department of ENT, Ministry of Health and Family welfare, Pali, Rajasthan, India

    Naresh Kumar Paliwal & Shraddha Sharma

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  1. Sunil Kumar Samdhani
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  2. Naresh Kumar Paliwal
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  3. Mahendra Singh Hada
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  4. Shraddha Sharma
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Correspondence to Shraddha Sharma.

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Ethical Approval

All procedures performed in the presented study involving human participants were in accordance with the ethical standards of the institutional ethical committee of SMS Medical College Jaipur (Letter no. 269/MC/EC/2020) dated declaration and its later amendments or comparable ethical standards.

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Written informed consent was obtained from all individual participants included in the study in native language.

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Samdhani, S.K., Paliwal, N.K., Hada, M.S. et al. Study to Evaluate the Pattern of Nodal Distribution in Papillary Thyroid Cancer. Indian J Otolaryngol Head Neck Surg 75, 1356–1362 (2023). https://doi.org/10.1007/s12070-023-03524-8

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  • DOI: https://doi.org/10.1007/s12070-023-03524-8

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