- Capsular extension at ultrasound is associated with lateral lymph node. - Background: In patients with papillary thyroid cancer (PTC), cervical lymph node metastasis (LNM) must be carefully assessed to determine the extent of lymph node dissection required and patient prognosis. - Few studies attempted to determine whether the ultrasound (US) appearance of the primary thyroid tumor could be used to predict cervical lymph node involvement. - 10 mm was significantly more common in the CLNM (70.2%) and LLNM groups (89.6%) than in the NLNM group (45.4. - 50% was most common in the LLNM group (35.4. - The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. - If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. - Papillary thyroid cancer (PTC) is a carcinoma that arises from the thyroid follicular cells, is classified as differenti- ated thyroid cancer, and accounts for about 80% of all thyroid cancers [1]. - In the United States, the incidence of PTC increased from 4.56 per 100,000 person-years in 1974–1977 to 14.42 per 100,000 person-years in . - Cells from the primary tumor in the thyroid gland first spread to the central and ipsilateral lateral lymph node compartments via lymphatic drainage and then to the mediastinal and contralateral lateral lymph node compartments [7–9].. - Thus, in patients with PTC, cervical lymph node involvement must be carefully assessed to determine the extent of lymph node dissection required and patient prognosis.. - Hence, it is beneficial to de- termine the significant ultrasound features that might indicate the presence of LNMs to help determine whether to perform central or lateral lymph node dissection.. - Although the usefulness of the US to detect cervical LNM in PTC patients has been extensively investigated, few studies attempted to determine whether the US ap- pearance of the primary thyroid tumor could be used to predict cervical lymph node involvement. - Therefore, the present study aimed to identify the US features of the primary thyroid tumor used to predict cervical lymph node involvement in patients with PTC.. - and 4) underwent lymph node dissection. - Each thyroid lobe was imaged in the longitudinal and transverse axes. - The presence or absence of chronic lymphocytic thyroiditis was also assessed in the US and confirmed on pathological examination. - In addition, all patients underwent modified radical central and lateral lymph node dissec- tion. - Central lymph node dissection included the dissec- tion of the pretracheal, prelaryngeal, and ipsilateral paratracheal lymph nodes. - Lateral lymph node dissection involved the dissection of the lymph nodes in groups II to V while sparing the internal jugular vein, spinal accessory nerve, and sternocleidomastoid muscle. - Lymph node metastases (macrometastases and micrometastases) and chronic lymphocytic thyroiditis were confirmed using the postoperative pathological examination. - Lateral neck dissection was performed in the following cases: 1) US indicated suspicious lymph node metastasis. - 2) during the oper- ation, it was found that the tumor was large and the lymph nodes in the central region were involved. - or 3) the tumor was large and close to the superior lymph nodes, and lymph node metastasis in regions II and III are frequent, and dissection was performed for preven- tion. - The patients were divided into three groups based on their lymph node status: (i) no LNM, NLNM group. - CLNM was defined as metastasis to the group VI lymph nodes (i.e., the central lymph nodes). - LLNM was defined as the involvement of the lymph nodes in groups II to V (i.e., the lateral lymph nodes) [17].. - Postoperative pathological examination confirmed PTC in 247 of these patients, who were included in the study. - The patients in the CLNM (mean age years) and LLNM groups years) were significantly younger than those in the NLNM group years) (P <. - 10 mm was significantly more common in the CLNM (70.2%) and LLNM groups (89.6%) than in the NLNM group (45.4%) (P <. - A round-to-ovoid shape was significantly more common in the LLNM group (81.3%) than in the NLNM (61.2%) and CLNM groups (76.6%) (P = 0.013). - 50% was most common in the LLNM group (35.4%) (P <. - The overall incidence of cervical LNM in the present study was approximately con- sistent with previous reports [6]. - Consistent with this, the present study showed that patients were more likely to be younger than 45 years old in the CLNM (72.3%) and LLNM groups (64.6%) than in the NLNM group (36.8%).. - In the present. - study, a taller-than-wide shape was significantly more common in the NLNM group (38.8%) than in the CLNM (23.4%) or LLNM group (18.7%).. - In the present study, capsular ex- tension >. - 50% was the most common in the LLNM group (35.4. - Microcalcification was frequently observed in the present study, but its incidence did not significantly dif- fer among the three groups. - In other words, when a capsular extension is found by US, the patient should be considered at a relatively high risk of LLNM, and the surgeons might consider performing lateral lymph node dissection.. - Table 1 Clinicopathological characteristics of the patients with papillary thyroid carcinoma ( n = 247). - NLNM no lymph node metastasis, CLNM central lymph node metastasis, LLNM lateral lymph node metastasis, SD standard deviation. - In the present study, tumor size was largest in the LLNM group (P <. - 10 mm was more frequent in the CLNM (70.2%) and LLNM groups (89.6%) than in the NLNM group (45.4%).. - A recent study revealed that Delphian lymph node (DLN) metastasis in PTC patients was related to tumor location in the isthmus or upper third of the thyroid [28]. - [30] found that thyroid nodules in the isthmus were more likely to be malignant than nodules elsewhere in the gland. - In the present study . - 247) of the patients had tumors in the middle third of the thyroid. - Only four patients had tumors located in the isthmus. - In the present study, the in- cidence of multifocality did not differ among the three groups.. - Hashimoto’s thyroiditis is the most common form of autoimmune thyroid disease, with an incidence rate of about 2% in the general population. - In the present study, the incidence of Hashimoto ’ s thyroid- itis did not significantly differ among the three groups.. - NLNM no lymph node metastasis, CLNM central lymph node metastasis, LLNM lateral lymph node metastasis. - In the present study, most of the tumors were hypoechoic, and the incidence of hypoechogenicity did not differ among the three groups. - NLNM: no lymph node metastasis;. - DLN: Delphian lymph node. - New developments in the diagnosis and treatment of thyroid cancer. - https://doi.org/1 0.3322/caac.21195.. - Trends in thyroid cancer incidence and mortality in the United States, 1974-2013. - https://doi.org/10.1001/jama.2017.2719.. - OR odds ratio, CI confidence interval, NLNM no lymph node metastasis, CLNM central lymph node metastasis, LLNM lateral lymph node metastasis. - Presence and number of lymph node metastases are associated with compromised survival for patients younger than age 45 years with papillary thyroid cancer. - https://doi.org/10.1200/JCO.2014.. - https://doi.org/10.1097/SLA.0b013e318230036d.. - https://doi.org . - Sonographic findings predictive of central lymph node metastasis in patients with papillary thyroid carcinoma: influence of associated chronic lymphocytic thyroiditis on the diagnostic performance of sonography. - 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https://doi.org/10.18632/. - https://doi.org/10.1 089/thy.2010.0372.. - https://doi.org/10.1089/thy.2007.0345.. - Skip lateral lymph node metastasis leaping over the central neck compartment in papillary thyroid carcinoma. - The effects of Hashimoto thyroiditis on lymph node metastases in Unifocal and multifocal papillary thyroid carcinoma: a retrospective Chinese cohort study. - https://doi.org/10.1097/MD . - Sonographic features of primary tumor as independent predictive factors for lymph node metastasis in papillary thyroid carcinoma. - https://doi.org/10.1 007/s z.. - Incidence and predictors of right paraesophageal lymph node metastasis of N0 papillary thyroid carcinoma located in the right lobe. - https://doi.org/10.1507/endocrj.EJ12-0362.. - https://doi.org/10.1089/ve.2020.0173.. - The effect of extent of surgery and number of lymph node metastases on overall survival in patients with medullary thyroid cancer. - https://doi.org/10.1210/jc.2013-2942.. - https://doi.org/10.18632/oncotarget.18620.
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