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
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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
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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
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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
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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
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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
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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
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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
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Del-phian
pretra-cheal
Rt.paratra-cheal
Lt.paratra-cheal
Central neck compartment specimen
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Results
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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%)
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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%)
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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*
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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*
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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
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Postoperative complications
Temporary V.palsy 2 (1.5%)
Permanent V.palsy 0 (0%)
Temporary hypoparathyroidism 17 (13.3%)
Permanent hypoparathyroidism 1 (0.8%)
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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