OP68 – Prevalence of Central Lymph Node Metastasis in Papillary Thyroid Cancer Patients with Uncertain Sonographic Patterns in the Preoperative Staging Ultrasound

     

    Plass, Ingrid2; Tala, Hernan1; Horvath, Eleonora3, Gonzalez, Paulina3; NIedman, JuanPablo3; Whittle, Carolina3; Capdeville, Felipe4; Madrid, Arturo4; Rojas, Hugo4; Rossi, Ricardo4, Valdes, Fabio4,  Slater, Jeannie5.
    1 Department of Endocrinilogy, Thyroid Center Division, Clinica Alemana de Santiago, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
    2 Head and Neck Surgery Resident, Clínica Alemana de Santiago, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
    3 Department of Radiology, Thyroid Center Division, Clinica Alemana de Santiago, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
    4 Department of Surgery, Head and Neck Surgery Division, Thyroid Center Division, Clinica Alemana de Santiago, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
    5 Department of Pathology, Thyroid Center Division, Clinica Alemana de Santiago, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile

     

    Background/Purpose: The clinical relevance of central lymph nodes (CLNs) with uncertain sonographic patterns (CLNUSP) on preoperative staging ultrasound (US) in Papillary Thyroid Carcinoma (PTC) still is not clear. We aim to establish the prevalence of clinically relevant CLNs metastasis (CRCM) in PTC patients with CLNUSP that underwent CLNs resection, either in the presence or absence of Hashimoto’s thyroiditis (HT).

    Methods: Retrospective IRB approved review of PTC patients with CLNUSP who underwent CLNs resection between 2013-2017 was performed. CLNUSP was defined as: prominent CLNs associated to HT or CLNs located next to the PTC identified. We excluded patients with suspicious CLNS on US. The US characteristics of CLNs and the presence or absence of HT on US was correlated with their pathological report. CRCM were defined as >5 metastatic CLNs (any size) or any metastasis >2mm. Prevalence of CRCM in patients with and without HT on US was assessed.

    Results: We reviewed 116 patients (80% women, median age 39 years). CLNs metastasis were present in 46%(53/116), 30% being CRCM (35/116). Amongst them, 13%(15/116) correspond to CRCM between 2-5mm and 17%(20/116) between 5-10mm.
    Prevalence of CRCM was 21%(15/70) and 46%(18/39) in patients with and without HT, respectively (p=0,007).

    Discussion and Conclusion: A third of patients with CLNUSP presented CRCM between 2-10mm, and a non-negligible 17% were between 5-10mm. When HT is present on US, 21% of patients with CLNUSP had CRCM. This should be taken in consideration in the decision whether to perform or not CLNs resection in this subgroup of patients.

     

    References:

    1. Randolph, Gregory W., Quan-Yang Duh, Keith S. Heller, Virginia A. LiVolsi, Susan J. Mandel, David L. Steward, Ralph P. Tufano, and for the American Thyroid Association Surgical Affairs Committee’s Taskforce on Thyroid Cancer Nodal Surgery R. Michael Tuttle. “The Prognostic Significance of Nodal Metastases from Papillary Thyroid Carcinoma Can Be Stratified Based on the Size and Number of Metastatic Lymph Nodes, as Well as the Presence of Extranodal Extension.” Thyroid 22, no. 11 (October 19, 2012): 1144–52. doi:10.1089/thy.2012.0043.
    2. Donangelo, Ines, Ann E. Walts, Catherine Bresee, and Glenn D. Braunstein. “LYMPHOCYTIC THYROIDITIS IS ASSOCIATED WITH INCREASED NUMBER OF BENIGN CERVICAL NODES AND FEWER CENTRAL NECK COMPARTMENT METASTATIC LYMPH NODES IN PATIENTS WITH DIFFERENTIATED THYROID CANCER.” Endocrine Practice: Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists 22, no. 10 (October 2016): 1192–98. doi:10.4158/E151078.OR.
    3. Haugen, Bryan R., Erik K. Alexander, Keith C. Bible, Gerard M. Doherty, Susan J. Mandel, Yuri E. Nikiforov, Furio Pacini, et al. “2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer.” Thyroid: Official Journal of the American Thyroid Association 26, no. 1 (January 2016): 1–133. doi:10.1089/thy.2015.0020.
    4. Lai, Xingjian, Bo Zhang, Yuxin Jiang, Jianchu Li, Ruina Zhao, Xiao Yang, Xiaoyan Zhang, et al. “Sonographic and Clinical Features of Papillary Thyroid Microcarcinoma Less than or Equal to Five Millimeters: A Retrospective Study.” PloS One 11, no. 2 (2016): e0148567. doi:10.1371/journal.pone.0148567.
    5. Sturgeon, Cord, Anthony Yang, and Dina Elaraj. “Surgical Management of Lymph Node Compartments in Papillary Thyroid Cancer.” Surgical Oncology Clinics of North America 25, no. 1 (January 2016): 17–40. doi:10.1016/j.soc.2015.08.013.
    6. Suman, Paritosh, Chi-Hsiung Wang, ShabirHusain S. Abadin, Tricia A. Moo-Young, Richard A. Prinz, and David J. Winchester. “Risk Factors for Central Lymph Node Metastasis in Papillary Thyroid Carcinoma: A National Cancer Data Base (NCDB) Study.” Surgery 159, no. 1 (January 2016): 31–39. doi:10.1016/j.surg.2015.08.032.

 

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    World Congress on Thyroid Cancer 3.5
    Rome, Italy | 2019

    World Congress on Thyroid Cancer 4.0
    July 29 – August 1, 2021
    Boston, Massachusetts

     

  • WCTC3.5 Steering Committee:

     

    Rocco Bellatone, Co-Chair
    Celestino Lombardi, Co-Chair
    Gregory W. Randolph, MD
    Bryan McIver, MD
    Jeremy Freeman, MD
    Ian J. Witterick, MD
    Ashok R. Shaha, MD
    Jatin P. Shah, MD