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Features of papillary thyroid microcarcinoma associated with lateral cervical lymph node metastasis
Author(s) -
Jeon Min Ji,
Chung Mi Sun,
Kwon Hyemi,
Kim Mijin,
Park Suyeon,
Baek Jung Hwan,
Song Dong Eun,
Sung TaeYon,
Hong Suck Joon,
Kim Tae Yong,
Kim Won Bae,
Shong Young Kee,
Lee Jeong Hyun,
Kim Won Gu
Publication year - 2017
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.13322
Subject(s) - medicine , metastasis , thyroid , cervical lymph nodes , lymph node , retrospective cohort study , gastroenterology , cancer
Summary Objectives Papillary thyroid microcarcinoma ( PTMC ) has an excellent prognosis with an indolent disease course. However, some PTMC s have an aggressive course with lateral cervical lymph node ( LCLN ) metastasis or distant metastasis. This study aimed to evaluate the pre‐operative features of PTMC associated with LCLN metastasis. Design and Patients This retrospective cohort study with a nested, matched case–control design included 199 PTMC patients with LCLN metastasis at initial surgery (N1b group) and 196 PTMC patients without any LN metastasis or persistent disease (N0 NED group) as controls; primary tumour sizes were matched. Results Compared with the N0 NED group, the N1b group was younger (<50 years) and more likely to be male ( P = 0·002 and P = 0·003, respectively). On pre‐operative neck ultrasonography ( US ), N1b group PTMC s were more commonly associated with a location in the upper lobes of the thyroid, or in the subcapsular area and microcalcifications than N0 NED group PTMC s (all P < 0·001). An increase in the number of these features was significantly associated with a higher risk of LCLN metastasis ( P < 0·001). Evaluation of the clinical and pre‐operative US characteristics of 26 patients with confirmed LCLN recurrence after initial treatment of clinical N0 PTMC s revealed that the distribution of the number of suspicious features in these patients was similar to that of the N1b group. Conclusions Papillary thyroid microcarcinomas in young (<50 years) or male patients, with an upper lobe or subcapsular location, and with microcalcification have a higher risk of LCLN metastasis. Individualized management according to the number of these suspicious features may be needed for small thyroid nodules.