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Incidental positive lymph nodes in patients with papillary thyroid cancer is independently associated with recurrent disease
Author(s) -
Kluijfhout Wouter P.,
Drake Frederick T.,
Pasternak Jesse D.,
Beninato Toni,
Vriens Menno R.,
Shen Wen T.,
Gosnell Jessica E.,
Liu Chienying,
Suh Insoo,
Duh QuanYang
Publication year - 2017
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24680
Subject(s) - medicine , papillary thyroid cancer , lymphadenectomy , thyroidectomy , lymph , neck dissection , lymph node , pathological , dissection (medical) , hazard ratio , retrospective cohort study , proportional hazards model , thyroid cancer , surgery , disease , thyroid , metastasis , cancer , radiology , pathology , confidence interval
Background and Objectives Pathological examination occasionally reveals incidental central lymph nodes metastasis (iLNM) after thyroidectomy for patients with papillary thyroid cancer (PTC) who did not undergo compartment‐orientated lymphadenectomy. We aimed to investigate the risk of recurrence for patients with iLNM. Methods We conducted a retrospective review of all patients undergoing total thyroidectomy for PTC (January 2000 to January 2010). Patients with distant metastases, central‐ or lateral neck dissection and pre‐operative suspicious lymph nodes (by ultrasound or clinical examination) were excluded. The association between iLNM and recurrent disease was investigated using Kaplan‐Meier survival estimates and Cox proportional hazards analysis. Results 225/1000 patients had incidental nodes after total thyroidectomy for PTC. 183 were node‐negative and 42 had iLNM. Mean age was 46 years and 201 (89%) were women. Mean number of resected nodes was 2.3. Disease recurred in 8/183 (4.4%) of patients with N0 versus 7/42 (17%) with iLNM. After adjusting for other factors, iLNM was independently associated with recurrent disease (hazard ratio = 4.01 [95% CI 1.21–13.3]). Conclusions Positive incidental lymph nodes are independently associated with recurrent disease in patients with PTC. These patients should therefore be monitored more carefully.