kee-hwan kwon, eun-jae chung, young-soo rho department of otolaryngology – head & neck surgery
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Patterns And Predictive Factors Of Contralateral Central Nodal Metastasis In Thyroid Papillary Carcinoma : Prospective Study Of Bilateral Central Lymph Node Dissection. Kee-Hwan Kwon, Eun-Jae Chung, Young-Soo Rho Department of Otolaryngology – Head & Neck Surgery - PowerPoint PPT PresentationTRANSCRIPT
Patterns And Predictive Factors Of Contralateral Central Nodal Metastasis In Thyroid Papillary
Carcinoma: Prospective Study Of Bilateral Central Lymph Node Dis-
section
Kee-Hwan Kwon, Eun-Jae Chung, Young-Soo Rho
Department of Otolaryngology – Head & Neck SurgeryIlsong Memorial Institute of Head and Neck Cancer
Hallym Univeristy Medical Center
Introduction
Prophylactic central lymph node dissection (CLND)
Negatively - higher rate of permanent hypoparathyroidism and
permanent nerve injury without evidence of survival benefit or better local control
- no additional morbidity as a secondary procedure after local recurrence
Positively - removal of microscopic disease in central lymph
nodes may prevent recurrence and improve overall survival without increased morbidity
- second operation on recurred central lymph nodes may increase the risk of complications
Introduction
ATA guideline prophylactic CLND (ipsilateral or bilateral)
as an option in the management of ad-vanced PTC (T3 or T4 )
not for small tumors (T1 or T2 classification), noninvasive or clinically node-negative PTC
Limitations of recent guidelines even in PTC with small tumors (T1 or T2),
there is a high possibility of CLN metastasis, rates of CLN metastasis are different in ac-
cord with various clinicopathologic parame-ters
Introduction
A few studies have suggested some risk fac-
tors for ipsilateral and contralateral CLN
metastasis in cases of PTC, but there is no
consensus about predictors
Prospective study with histopathologic in-
formation and risk factors analysis in PTC
patients with clinically only contralateral
negative neck nodes
Purpose
The objective of this study was to determine
the pattern and the predictive factors for oc-
cult contralateral central neck lymph node
metastasis, prospectively
Material & Methods
Prospective study
127 PTC patients with clinically node-nega-
tive contralateral central neck
Between 2010 and 2011
Ilsong Memorial Institute Head and Neck
Cancer, Hallym University College of
Medicine
Preoperative ultrasonography was per-
formed on every patient
Material & Methods
16 men, 121 women
mean age: 49.5 years; range 29-76 years
Total thyroidectomy & bilateral CND
Central neck compartment specimens
Dephian
Ipsilateral paratracheal
contralateral paratracheal
Pretracheal
Del-phian
pretra-cheal
Rt.paratra-cheal
Lt.paratra-cheal
Central neck compartment specimen
Results
Characteristics of patients with PTC
Variables Number (%)
Age<45≥45
43 (33.9%)84 (66.1%)
Mean tumor size (cm)<1 cm ≥1 cm
1.04 cm (range 0.1 - 10)75 (59.1%)52 (40.9%)
MultiplicityNoYes
84 (66.1%)43 (33.9%)
Extrathyroidal extensionNoYes
80 (62.9%)47 (37.1%)
Bilaterality (pathologic)NoYes
98 (77.2%)29 (22.8%)
Pattern of lymph node metastasis
Central node metasta-sis
:44/ 127 patients (34.6%) Lateral neck node
metastasis : 18/127 patients (14.2%) Ipsi para + pretracheal : 16/ 127 (12.6%) Ipsi paratracheal + del-
phian : 5/ 127 (3.9%) Ipsi para + pre + del-
phian : 4/ 127 (3.1%)
Delphian:8/ 127 (6.3%)
Pretracheal: 25 (19.7%)
IpsiParatracheal:32/ 127 (25.2%)
ContraParatracheal: 13/ 127 (10.2%)
Univariate analysis of clinicopathologic characteristics re-lated to contralateral central lymph node metastasis
Variables Contra- Contra+ p-value
Age<45≥45
3480
94
0.01*
Mean tumor size<1 cm ≥1 cm
7143
49
0.038*
MultiplicityNoYes
7836
67
0.128
Bilaterality (pathologic)NoYes
9024
85
0.171
Extrathyroidal extensionNoYes
7539
58
0.05*
Variables Contra- Contra+ p-value
Ipsilateral paratracheal nodeNoYes
9420
112
<0.001*
Pretracheal nodeNoYes
9915
310
<0.001*
Delphaian nodeNoYes
1095
103
0.035*
Ipsi para & pretracheal nodeNoYes
1077
49
<0.001*
Ipsi para & delphian nodeNoYes
1122
103
0.008*
Ipsi para & pretracheal & del-phian
NoYes
1140
94
<0.001*
Lateral neck nodeNoYes
1068
310
<0.001*
Multiple logistic regression analysis for contralateral central lymph node metastases
Variables p-valueAge (<45 yrs) 0.035*
(Odd ratio 18.652, 95% CI 1.232-282.468)
Tumor size (1cm) 0.696
Extrathyroidal extension 0.918
Ipsilateral paratracheal node 0.997
Pretracheal node 0.997
Delphian node 1.000
Lateral neck node 0.03*(Odd ratio 18.672, 95% CI 1.324-
263.298)Ipsi para & pretracheal node 0.997
Ipsi paratracheal & dephian node
1.000
Ipsi para & pre & delphian node 0.999
Postoperative complications
Temporary V.palsy 2 (1.5%)
Permanent V.palsy 0 (0%)
Temporary hypoparathyroidism 17 (13.3%)
Permanent hypoparathyroidism 1 (0.8%)
Conclusion
Contralateral central lymph node metastases were sig-
nificantly associated with age, tumor size, ECS, ipsilat-
eral para/ pretracheal/ delphain and lateral neck com-
partment node metastasis
On multivariate analysis, lateral neck lymph node
metastasis (with young age) was an independent pre-
dictive factor of contralateral central compartment
metastasis