Spinelli, C.1, Tognetti, F.1, Strambi, S.1, Paolini, S.1, Cecchetto, G.2, Bisogno, G.3, Ferrari, A.4, Inserra, A.5, Collini, P.6, Massimino, M.4
1 Division of Pediatric and Adolescents Surgery, Department of Pathology Surgery, University of Pisa, Pisa, Italy
2 Department of Women’s and Children’s Health, Pediatric Surgery Unit, University Hospital of Padua, Padua, Italy
3 Hematology-Oncology Division, Department of Pediatrics, University Hospital of Padua, Padua, Italy
4 Pediatric Oncology Unit, Istituto Nazionale Tumori, Milan, Italy
5 Division of Pediatric Surgery, Bambino Gesù Children’s Hospital, Rome, Italy
6 Department of Diagnostic Pathology and Laboratory Medicine, Istituto Nazionale Tumori, Milan, Italy
Background/Purpose: the aim of our study was to identify predictive factors for lymph node metastasis (LNM) in central (CC) and lateral compartments (LC) in pediatric papillary thyroid carcinoma (PTC).
Objectives: to improve the outcome of pediatric patients with PTC by choosing promptly a tailored approach.
Methods: a multicentric retrospective analysis was conducted about 132 patients affected by PTC, treated between 2000 and 2014. Age, gender, tumor size, histological subtype, infiltration of the capsule, vascular invasion, LNM, multifocality, and persistence/recurrence of the disease were analyzed.
Results: total thyroidectomy was performed in 132 patients, followed by lymph node dissection in 87 (65,9%): LNM was confirmed in 73 (55.3%). Among these, 25 (18.9%) were in the LC, 17 (12.9%) in the CC, and 31 (23.5%) involved both. Median age was 14.3 ± 3.2 years (range 4-18 years); 75.8 % of the patients were female. Multifocality (P<.00), vascular invasion (P=.04), infiltration of the thyroid capsule (P<.00), minimal extrathyroidal extension (P<.00), and diffuse sclerosing variant (P=.02) were significantly associated with LNM in CC. Infiltration of the thyroid capsule (P<.00), extended extrathyroidal extension (P=.03), distant metastases (P=.02), convectional PTC (P<.00) and presence of LNM in the CC (P<.00) were significantly associated with LNM in LC.
Discussion & Conclusion: meticulous peri-operative evaluation of LNM is required for PTC patients with the above predictors. In our study, LNM in CC have been reported to increase the risk of persistence and recurrence of PTC therefore an even more strict approach in the management of these patients should be regarded.