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In the treatment of papillary thyroid carcinoma (PTC), supplementary lymph node dissection (LND) is not well standardized. The purpose of this study was to evaluate the significance of the cervical compartments in the lymphatic spread of PTC and the impact of modified radical neck dissection (MRND) as an additional surgical procedure to thyroid res...
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... the 20 patients with lymph node metastases in compartment B, 13 patients (65%) were also found to have positive nodes in the contralateral compartment C. The distribution of the invaded lymph nodes in the MRND surgical specimen of compartments B and C did not demonstrate any obvious pattern of having affected the anatomic lymphatic levels. All operated patients free of lymph node metastasis in compartment A (n =14) were also free of me- tastases in both lateral compartments (Table 2). ...
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Background:
Carcinoma of the thyroid gland is one of the most commonly encountered endocrine malignancies. Papillary carcinoma is the most common histological type, and its spread is usually lymphatic. About 30-80% patients with papillary carcinoma develop lymphatic metastases.
Case report:
We present here the case of a 70-year-old female patien...
Purpose
Papillary thyroid carcinoma (PTC) arising from the pyramidal lobe is rare; therefore, clinicopathologic evaluation is lacking. In addition, the rate of occult malignancy in the pyramidal lobe after thyroid surgery is unclear. This study is to evaluate the clinical characteristics of PTCs that involve the pyramidal lobe.
Methods
The study e...
Citations
... However, postoperative hypoparathyroidism caused by parathyroid injury is still a problem faced by thyroid surgeons [5]. The incidence of temporary and permanent hypoparathyroidism after thyroidectomy is 14-60% and 4-11%, respectively [6][7][8][9][10][11][12][13]. Some studies have reported the surgical experience of a surgeon, central lymph node dissection, and malignant tumors are risk factors for damaging the parathyroid glands during thyroidectomy [14][15][16].During radical thyroidectomy, thyroid specialists must rely on their experience to distinguish the parathyroid glands from many lymph nodes in the connective tissue on the dorsal side of the thyroid. ...
Background
Postoperative hypoparathyroidism caused by parathyroid injury is a problem faced by thyroid surgeons. The current technologies for parathyroid imaging all have some defects.
Methods
Patients with differentiated thyroid carcinoma (DTC) who underwent unilateral thyroidectomy plus ipsilateral central lymph node dissection were recruited. We dissected the main trunk of the superior thyroid artery entering the thyroid gland and placed the venous indwelling tube into the artery. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated.
Results
A total of 132 patients enrolled in this single-arm clinical trial, 105 of them completed retrograde catheterization via the superior artery. The sensitivity was 69.23 and 83.33% respectively. The specificity was 72.91 and 64.89%. The accuracy was 72.91 and 64.89%. The PPV was 85.71 and 81.08%. The NPV was 22.58 and 45.45%. There were no patients with allergic reactions to the methylene blue, or methylene blue toxicity.
Conclusions
Retrograde injection of methylene blue via the superior thyroid artery is an effective and safe method to visualize parathyroid glands. This method can accurately locate the target organ by ultraselecting the blood vessel and injecting the contrast agent while avoiding background contamination and reducing the amount of contrast agent.
Trial registration
Clinical trial registration numbers and date of registration: ChiCTR2300077263、02/11/2023.
... The spread of PTC passes through the lymphatic system in a predictable stepwise pattern. Lymphatic metastasis in PTC involves firstly the ipsilateral central compartment then the contralateral central compartment, then the ipsilateral lateral compartment, and lastly the contralateral lateral compartment and the mediastinal lymph nodes (LNs) [5][6] . ...
Background: Cervical lymph node metastasis is a prognostic factor in papillary thyroid carcinoma (PTC). Metastasizing PTC to cervical lymph nodes is very common and occurs in 30-80% of patients. Aim: To investigate the risk factors of skip lateral lymph node metastasis in PTC patients. Methods: This retrospective study was conducted at a single institution and included PTC patients treated in the period between 2018 and 2021. All patients with PTC who underwent total thyroidectomy with central and lateral block neck dissection were reviewed for skip metastases which was confirmed by histopathologic examination. Results: During the study period, 267 patients with PTC underwent total thyroidectomy with central and/or lateral block neck dissection. Among them, only 64 patients matched the study inclusion criteria and their pathology was reviewed for skip metastases. Thirteen (20.3%) patients showed skip metastases. Their mean (±SD) age was 50.1 (±16.7) years and 8 (61.5%) were females. Only age ≥40 years and tumor size ≤0.5 cm differed significantly between patients with skip metastasis and those without. Conclusions: The results support the conduction of a prospective multi-centric study with a larger sample size to better understand the risk factors for developing skip metastasis in PTC. This would help in selecting patients with a risk for skip metastasis.
... Related symptoms include paraesthesia, asthenia, muscle cramps, and tetany, which may progress to seizures, bronchospasm, laryngeal spasm, and cardiac dysrhythmia. Over time, chronic hypocalcaemia may lead to nephrocalcinosis with kidney stones, chronic kidney disease, myocardial dysfunction, neurologic disorders, and neurocognitive derangement (2), the most common complication following total thyroidectomy in many series, ranging from 4 to 60% (3,4,5,6,7,8,9,10,11). Transient HPT (tHPT) can develop within 24 h after surgery and can require calcium and vitamin D supplementation for several weeks before recovery. ...
... We found that group cT showed significantly lower rates of tHPT than group TT (14.77% vs 25.59%; P < 0.0001). These results are almost in line with what has been reported by other authors (4,6,8,9,10), who report tHPT rates from 14 to 60%. Rafferty et al. (26) found that the rate of tHPT was significantly higher in patients treated with total thyroidectomy than in those treated with two-stage thyroidectomy (27.1% vs 7.0%; P = 0.006). ...
Objective
Thyroid surgery may lead to postoperative complications. The aim of this paper was to determine whether the rate of postoperative hypoparathyroidism (HPT) is influenced by whether surgery is staged.
Design
Single-institution retrospective observational study.
Methods
The clinical records of 786 patients treated at the Otolaryngology Unit of the Azienda USL-IRCCS di Reggio Emilia between January 1990 and December 2015 were reviewed. Patients were divided into two groups according to the surgical treatment received: Group TT (637 patients, 81.04%) underwent single-stage total thyroidectomy; Group cT (149 patients, 18.96%) underwent loboisthmusectomy and delayed completion total thyroidectomy. Transient and permanent HPT, assessed after 6 months of follow-up, were the primary endpoints. Risk factors of postoperative HPT were also analysed as secondary outcomes.
Results:
Rates of transient HPT in Group TT were higher than those observed in Group cT, (P = 0.0057). Analysis of risk factors identified sex as an independent risk factor for transient HPT only for Group TT (P = 0.0012) and the number of parathyroid glands remaining in situ (PGRIS) as an independent risk factor for transient and permanent HPT for Group TT (P <0.0001 and P = 0.0002, respectively).
Conclusions
This study suggests that the risk of transient postoperative HPT is lower in patients that undergo completion thyroidectomy. Further independent risk factors for postoperative HPT are female sex and PGRIS score. In light of the growing use of conservative surgery for thyroid neoplasms, these findings could help to adequately plan surgery in order to reduce endocrine complications.
... Related symptoms include paraesthesia, asthenia, muscle cramps, and tetany, which may progress to seizures, bronchospasm, laryngeal spasm, and cardiac dysrhythmia. Over time, chronic hypocalcaemia may lead to nephrocalcinosis with kidney stones, chronic kidney disease, myocardial dysfunction, neurologic disorders, and neurocognitive derangement (2), the most common complication following total thyroidectomy in many series, ranging from 4 to 60% (3,4,5,6,7,8,9,10,11). Transient HPT (tHPT) can develop within 24 h after surgery and can require calcium and vitamin D supplementation for several weeks before recovery. ...
... We found that group cT showed significantly lower rates of tHPT than group TT (14.77% vs 25.59%; P < 0.0001). These results are almost in line with what has been reported by other authors (4,6,8,9,10), who report tHPT rates from 14 to 60%. Rafferty et al. (26) found that the rate of tHPT was significantly higher in patients treated with total thyroidectomy than in those treated with two-stage thyroidectomy (27.1% vs 7.0%; P = 0.006). ...
1. The correct localization of parathyroid adenomas is one of the main difficulties during mini‐invasive parathyroidectomy.
2. To ease the surgical localization of pathological parathyroid tissue and reduce surgical manipulation, we have introduced in our clinical practice a bidimensional visual map based on preoperative ultrasonography.
3. The ultrasonography‐based visual map is a reliable tool which can be easily consulted by the surgeon preoperatively and during surgery.
4. The map is drawn with the aim of representing the exact localization of adenomas respecting their borders with other organs (i.e., esophagus, thyroid lobe, carotid artery).
5. The use of the ultrasonography‐based visual map can minimize surgical manipulation, thus reducing the risk of recurrent laryngeal nerve injury.
... However, according to other studies, lymph node metastasis (LNM), especially cervical lymph node metastasis (CLNM), occurs in over 50% of patients with PTC [4,5]. It is possible that besides being an independent risk factor for lateral lymph node metastasis (LLNM) [6][7][8][9], CLNM also elevates the recurrence rate and disease-specific mortality [10][11][12]. Repeated surgery may lead to an increase of complications, such as damage to the recurrent laryngeal nerve and hypoparathyroidism, which affect the life quality of patients. ...
... e relationship between positive central lymph nodes and LLNM may be explained by the dissemination of PTC through the lymphatic system [27,28]. Lymph node metastases tend to occur in consecutive orders from the central compartment, followed by the lateral compartment and then mediastinal lymph nodes [6,29]. Metastases in the lateral compartment without positive central lymph nodes are very rare [30]. ...
Objective:
To identify the risk factors for cervical lymph node metastasis (CLNM) and the feasibility of prophylactic central lymph node dissection.
Methods:
The characteristics of 1107 patients were extracted and analyzed. Univariate and multivariate analyses were used to identify risk factors associated with lymph node metastasis. The relationship between the central lymph node dissection (CLND) and lateral lymph node metastasis (LLNM) was analyzed using the correlation analysis.
Results:
The probability of CLNM was closely related to the male gender, age <55, and the increase of tumor size. Those patients with an increase in tumor size and CLNM were extremely prone to LLNM. Also, LLNM was more likely to happen in those with the more positive central lymph nodes. Routine prophylactic central lymph node dissection (P-CLND) did not increase the risk of complications.
Conclusion:
P-CLND should be considered as a reasonable surgical treatment for PTC.
... Contralateral occult level VI nodes are present in 10-25% of patients with PTC [19,25]. Furthermore, the risk of central compartment metastases is even higher when there are jugular chain metastases [26]. As a result, the overall risk of occult nodal metastases in patients with PTC is over 80% [3]. ...
Objective
Lateral and central compartments cervical lymph nodes metastases are common among patients with papillary thyroid carcinoma (PTC). Elective level VI neck dissection during thyroidectomy and lateral neck dissection (LND) for the treatment of PTC with lateral compartment lymph node metastases is controversial because of the uncertain benefit in clinical outcomes and increased risks of surgical morbidity.We aimed to determine the potential benefit of elective level VI neck dissection in patients with cN1 papillary thyroid carcinoma (PTC) by investigating the rate and pattern of locoregional recurrence in PTC patients who underwent total thyroidectomy and therapeutic lateral node dissection (LND; levels II–IV) without elective level VI dissection.MethodsA retrospective cohort study. Data on demographics, clinical presentation and workup, intraoperative and pathological report, postoperative course, adjuvant therapy, recurrence patterns, and overall survival were retrieved from the medical charts of patients who underwent thyroid surgery in our hospital between January 2006 and December 2017.ResultsA total of 1415 thyroidectomies were performed during the study period, of which 802 (56.67%) were for PTC. Of those PTC patients, 228 (28.42%) also underwent LND (levels II–VI) during the same thyroidectomy procedure. Thirty-four (14.91%) of those 228 patients, underwent total thyroidectomy with therapeutic lateral ND II–IV without elective level VI ND. During the follow-up period, five (14.7%) of the latter cohort were diagnosed with recurrence in central neck (level VI) lymph nodes, and four of them (11.7%) were diagnosed with ipsilateral recurrence at level VI.Conclusion
Our results revealed 11.7% rate of clinically significant recurrent disease in ipsilateral level VI which, in our opinion, does not justify routine prophylactic level VI ND dissection when the ipsilateral lateral neck is operated for metastases.
... Advocates point that prophylactic CLND in cN0 patient reduces local recurrence which contributes to less hazardous reoperative surgery [6,7,13]. In our country, given the combination of higher CNM risks in Asian patients and unreliability of preoperative examinations in detecting CNM [14], most institutions prefer thyroidectomy with prophylactic CLND. In this study, the rate of patients who received ...
Purpose:
Central lymph node metastasis (CNM) are highly prevalent but hard to detect preoperatively in papillary thyroid carcinoma (PTC) patients, while the significance of prophylactic compartment central lymph node dissection (CLND) remains controversial as a treatment option. We aim to establish a nomogram assessing risks of CNM in PTC patients, and explore whether prophylactic CLND should be recommended.
Materials and methods:
One thousand four hundred thirty-eight patients from two clinical centers that underwent thyroidectomy with CLND for PTC within the period 2016-2019 were retrospectively analyzed. Univariate and multivariate analysis were performed to examine risk factors associated with CNM. A nomogram for predicting CNM was established, thereafter internally and externally validated.
Results:
Seven variables were found to be significantly associated with CNM and were used to construct the model. These were as follows: thyroid capsular invasion (TCI), multifocality, creatinine (Cr) >70 μmol/L, age < 40, tumor size >1 cm, body mass index (BMI) < 22, and carcino-embryonic antigen (CEA) > 1 ng/ml. The nomogram had good discrimination with a concordance index (C-index) of 0.854 (95% confidence interval [CI], 0.843 to 0.867), supported by an external validation point estimate of 0.825 (95% CI, 0.793 to 0.857). A decision curve analysis (DCA) was made to evaluate nomogram and ultrasonography for predicting CNM.
Conclusion:
A validated nomogram utilizing readily available preoperative variables was developed to predict the probability of central lymph node metastases in patients presenting with PTC. This nomogram may help surgeons make appropriate surgical decisions in the management of PTC, especially in terms of whether prophylactic CLND is warranted.
... Lymph node metastase (LNM) in PTC is usually found in Level VI, which is named as central CLNM and is the first station of LNM followed by lateral CLNM [4]. Central CLNM can be found in about 20-90% of PTCs and it is hard to be detected before surgery: the sensitivity for central CLNM detection by high-frequency ultrasound (US) is lower than 50% due to the interference of gas, glands and bone [5]. ...
Aim: To compare the value of predictive power of the models for central cervical lymph node metastasis (CLNM) in papillary thyroid carcinomas (PTCs). Patients & methods: 220 PTCs were prospectively enrolled into the study with pathological examination. We established a new risk model with univariate and multivariate analyses and receiver-operating characteristic curves were plotted. Z-test was performed to compare the area under two curves and validated the predictive model for central CLNM in PTCs. The comparison of previous and new predictive model was analyzed. Results: Microcalcification, capsule contact or involvement, internal flow and BRAF V600E mutation were four independent risk factors for PTCs with central CLNMs. The area under the curves for the new and the previous model were 0.948 and 0.934 (p = 0.572), respectively. Conclusion: Two predictive models showed strong consistency in predicting central CLNM in PTCs. The predictive model may be helpful in selecting appropriate treatment method in PTCs.
... The cervical lymph node metastasis of PTC occurs firstly in the central compartment and then infiltrates to the lateral region in general [19]. For cN0 patients, a "wait and see" strategy is applied in some clinical centers, and central lymph node dissection is also conducted routinely in several regions considering high rate of level VI lymph nodes involvement, and relatively low risk of surgery-related complications. ...
PurposeTo effectively predict lateral neck lymph nodes (LLN) metastasis in papillary thyroid carcinoma (PTC) patients with central lymph nodes (CLN) invasion, and devise targeted treatment strategies.Methods
Four hundred and thirty-four PTC patients with CLN metastasis from two medical centers were retrospectively analyzed. A new statistical model was established for predicting LLN involvement in these patients to guide lymph nodes management strategies.ResultsPatients with more than five positive CLN metastasis appeared to have extremely high risk (83.0%) of LLN involvement. For patients with five or less positive CLN invasion, multivariate logistic analyses were applied. Independent risk factors for LLN involvement were determined to be: age over 40, maximum tumor diameter of no less than 1.0 cm, existence of thyroid capsular invasion, and tumor with ipsilateral nodular goiter (iNG). These factors were used to construct a predictive nomogram. The accuracy and validity of our newly built model were verified by C-index 0.761 (95% CI, 0.707–0.815) in development cohort and 0.759 (95% CI, 0.745–0.773) in validation cohort and calibration curve. The patients were stratified into three groups based on their nomogram risk scores. Possible LLN involvement rates for low-risk, moderate-risk, and relatively high-risk subgroups were 8.9%, 22.8%, and 48.2%, respectively.Conclusions
Our newly established model can effectively predict possible LLN metastasis in PTC patients, and a new strategy selection flow chart was created for patients with positive CLN invasion. For patients in high-risk group, prophylactic LLN dissection is recommended, if not, adjuvant radioactive iodine or a closer follow-up scheme should at least be conducted. For those in low-risk group, surgical intervention is unnecessary and regular follow-up is recommended.
... Then, LNM involves ipsilateral lateral compartment and followed by the contralateral lateral compartment and the mediastinal lymph nodes. 42,43 This regularity might also contribute to the ignorance of skip metastasis. ...
Background
Skip metastasis is a special type in cervical lymph node metastasis (LNM) of patients diagnosed with papillary thyroid carcinoma (PTC) which induced poor prognosis. There are few studies about skip metastasis and conclusions remained uncertain. Therefore, this study aims to explore the frequency and to investigate risk factors of skip metastasis in PTC.
Methods
Through searching the keyword by PubMed and Embase databases which articles published up to 1st August 2018 about skip metastasis in papillary thyroid carcinoma, we extract data in order to assure whether those materials meet the criteria.
Results
The prevalence of skip metastasis is 12.02% in light of our meta-analysis of 18 studies with 2165 patients. The upper pole location (RR = 3.35, 95% CI =1.65–6.79, P = 0.0008) and tumors size ≤1 cm (RR = 2.65, 95% CI =1.50–4.70, P = 0.0008) are significantly associated with skip metastasis, whereas lymphovascular invasion (RR = 0.33, 95% CI =0.15–0.75, P = 0.0083) exists lower rate of skip metastasis. Multifocality, gender, age, bilaterality, thyroiditis and Extrathyroidal extension (ETE) are insignificantly associated with skip metastasis. Level II and level III are the most frequently affected areas.
Conclusion
The lateral compartment should be carefully examined especially for those PTC patients who present primary tumors in the upper lobe with a primary tumor size ≤10 mm which could be detected with skip metastasis.
