Journal of Anesthesia & Surgery

ISSN: 2473-2184

Impact Factor: 0.643

VOLUME: 4 ISSUE: 2

Page No: 199-202

Risk factors of lymph node metastasis in central region of thyroid micropapillary carcinoma


Affiliation

XING ZHAO1,   MINGZHEN ZHAO2,   GANG ZHANG3

1. Department of Pathology, Affiliated Hospital of Chengde Medical College, Chengde, Hebei 067000;

2. Experimental Center,Affiliated Hospital of Chengde Medical College, Chengde, Hebei 067000;

3. Department of General Surgery IV, Baoding First Hospital, Baoding, Hebei 071000, P.R. China

Citation

Xing Zhao, Mingzhen Zhao, Gang Zhang, Risk factors of lymph node metastasis in central region of thyroid micropapillary carcinoma(2022) Journal of Anesthesia & Surgery 4(2) :199-202

Abstract

Objective: To investigate the correlation between clinico-pathological features and lymph node metastasis of thyroid micropapillary carcinoma (PTMC).

Methods: the clinico-pathological data of 142 cases of thyroid micropapillary carcinoma were collected, the relationship between sex, age, tumor location, multi-focality and  cervical lymph node metastasis was analyzed.

Results: There was a high rate of lymph node metastasis in male patients with PTMC. There was no significant correlation between age, multifocality and lymph node metastasis.

Conclusion: The histological subtypes of PTMC have different clinicopathological characteristics and are important factors for cervical lymph node metastasis. Further evaluation of its histological classification is helpful for clinical treatment strategy.

Key words: lymph node metastasis;  thyroid micropapillary carcinoma

Introduction

Thyroid cancer is one of the most common malignant tumors in the endocrine system in recent years, along with thyroid ultrasound as a routine physical examination  technology. The thyroid ultrasound makes the detection rate of thyroid tumors significantly higher. The incidence rate of thyroid cancer shows a significant upward trend in the world. The World Health Organization (WHO) defines  thyroid micropapillary carcinoma( PTMC)as papillary thyroid carcinoma (PTC) with a maximum diameter ≤ 1 cm and regarded it as a subtype of PTC.PTMC is generally considered a low risk tumor, but there is indeed a risk of local recurrence and metastasis. As a histological subtype of the PTC, the risk factors of lymph node metastasis were still not to be confirmed. This study mainly  investigates the correlation between clinico-pathological features and lymph node metastasis of thyroid micropapillary carcinoma (PTMC),  expecting helpful for clinical treatment strategy.

Materials & Methods

2.1. Clinical data

The pathological data of 142 patients with PTMC from January 2018 to August 2018 in the pathology department of the Affiliated Hospital of Chengde Medical College were selected, including 22 males (15.49%) and 120 females (84.51%). The average age was 47.06 ± 9.59. < 45 years old  47 cases (33.10%) ,≥ 45years old 95 cases (66.90%) .There were 106 cases (74.65%) with single foci, including 52 cases in the left side, 54 cases in the right side, and 36 cases (25.35%) with multiple foci. There were 100 cases (70.42%) without cervical lymph node metastasis and 42 cases (29.58%) with positive lymph node metastasis.

2.2. Methods

Thyroid surgical specimens were routinely fixed with 4% neutral formaldehyde solution for 24 hours, routinely dehydrated, paraffin embedded, sectioned, and stained with HE. All the sections were analysed by experienced pathologists with double-blind method. The clinicopathological data of thyroid micropapillary carcinoma were analyzed by SPSS 19.0. The relationship between the gender, age, single focus / multiple focus and the positive rate of cervical lymph node metastasis were further analyzed. P < 0.05 was statistically significant.

2.3. Statistical analysis

SPSS 19.0 statistical software package was used for analysis. The distribution of pathological types was compared byc2test, and the difference was statistically significant if P < 0.05.

Results

3.1. The Correlation between gender and Cervical lymph node metastasis of PTMC

Among the 142 patients with PTMC, 22 were male (15.49%), of which 13 were negative for lymph node metastasis and 9 were positive, the positive rate was 40.91%. 120 cases (84.51%) were female, of which 87 cases were negative for lymph node metastasis and 33 cases were positive, the positive rate was 27.5%. There was statistical significance between the two groups (P = 0.048), and the  rate of lymph node metastasis was higher in males.

3.2. The correlation analysis between age and cervical lymph node metastasis of PTMC

Among the 142 patients with PTMC, the average age was 47.06 ± 9.59 years old (25-69 ). <45 years old 47 cases  (33.10%) , among which , 30 patients were negative for lymph node metastasis and 17 patients were positive, the positive rate of lymph node metastasis was 36.17%.  ≥ 45 years old 95 cases (66.90%), including 70 cases with negative lymph node metastasis and 25 cases with positive, the positive rate of lymph node metastasis was 26.32%. There was no significant difference between the two groups (P = 0.217).

3.3. The correlation analysis between multifocality of PTMC and cervical lymph node metastasis

Among the 142 patients with PTMC, 106 (74.65%) cases had a single tumor, of which 78 were negative for lymph node metastasis and 28 were positive, the positive rate of lymph node metastasis was 26.42%. 36 cases (25.35%) were multifocal, among which 22 cases were negative and 14 cases were positive, the positive rate of lymph node metastasis was 38.89%. There was no significant difference between the two groups (P = 0.098).

Discussion

Papillary thyroid carcinoma (PTC) is a common seen endocrine system tumor , and it has a tendency of rapid development in recent years with the improvement of ultrasonic diagnostic technology and the application of Fine Needle Aspiration. PTC with a maximum diameter ≤ 1 cm was defined to be PTMC[1,2]. The detection rate of PTMC has increased year by year. In spite of favorable outcome, the patients infected by PTMC still face the risk of recurrence. Presence of neck lymph node metastasis in PTMC patients is a high risk factor leading to poor prognosis. Therefore, it is necessary to analyze the risk factors of cervical lymph nodes metastasis to reduce the risk of metastasis and recurrence for PTMC.

The patient's age was one of the important indicators of the prognosis in PTMC. It is generally recognized that > 45 years is a risk factor for lymph node metastasis and  recurrence. But in some study[3,4]. , it was found that the node metastasis is higher in young patients. Zhang et al[5] investigated that, the patient <45 years old with PTMC presented high risk factor for central lymph node metastasis. Some scholars [6,7]believe that young PTMC patients can be observed regularly , not immediate surgery. Because  young patients have an increased risk of lymph node metastasis, early detection, early diagnosis and early treatment should be considered. In our study, there was no significant difference between the two groups.

Papillary thyroid cancer occurs mostly in female, and the male to female 1:3.  In this study, the number of female patients(84.51%)  was more than that of male patients(15.49%) . Some study  [8,9]showed the rate of cervical lymph node metastasis in male patients is higher than that in female patients. This may be related to the high hormone level of male patients. In our study, among the 142 patients with PTMC, 22 were male (15.49%), of which 13 were negative for lymph node metastasis and 9 were positive, the positive rate was 40.91%. 120 cases (84.51%) were female, of which 87 cases were negative for lymph node metastasis and 33 cases were positive, the positive rate was 27.5%. There was statistical significance between the two groups (P = 0.048), and the  rate of lymph node metastasis was higher in males.

A study including 933 cases[10] of PTMC patients found that, patients with multi-focal PTMC was 17.9 times higher than that of single focus in lymph node metastasis. If multi-focal, the clearance of lymph nodes in central area is needed.

Although PTMC is understood as an "inert" tumor, there are still a small number of tumor patients with poor prognosis[11,12]. Different patients need to receive individualized treatment, according to the patient Clinical information, immunological tissue markers, and BRAF gene and other factors.

Acknowledgement

Funding

CHENGDE Science and Technology Research and Development Program. NO.202109A056.

References

  1. Han Zhijiang,Xie Lesi,Wei Peiying,Lei Zhikai,Ding Zhongxiang,Zhang Ming. Ultrasound gray scale ratio for differential diagnosis of papillary thyroid microcarcinoma from benign micronodule in patients with Hashimoto's thyroiditis[J]. BMC Endocrine Disorders,2022,22(1): 187-187 PMid:35869461

    View Article      PubMed/NCBI     
  2. Liu Wen,Yan Xuejing,Dong Zhizhong,Su Yanjun,Ma Yunhai,Zhang Jianming,Diao Chang,Qian Jun,Ran Tao,Cheng Ruochuan. A Mathematical Model to Assess the Effect of Residual Positive Lymph Nodes on the Survival of Patients with Papillary Thyroid Microcarcinoma[J]. Frontiers in Oncology,2022,12: PP 855830-855830. PMid:35847961

    View Article      PubMed/NCBI     
  3. Liu XiaoNan,Duan YuanSheng,Yue Kai,Wu YanSheng,Zhang WenChao,Wang XuDong. The optimal extent of lymph node dissection in N1b papillary thyroid microcarcinoma based on clinicopathological factors and preoperative ultrasonography.[J]. Gland surgery,2022,11(6):PP 1047-1056. PMid:35800750

    View Article      PubMed/NCBI     
  4. De Carlos Joaquín,Ernaga Ander,Irigaray Ana,Pineda Jose Javier,Echegoyen Ana,Salvador Pilar,Anda Emma. Incidentally discovered papillary thyroid microcarcinoma in patients undergoing thyroid surgery for benign disease.[J]. Endocrine,2022,77(2): PP 325-332. PMid:35639243

    View Article      PubMed/NCBI     
  5. Zhang L , Wei WJ , Ji QH , et al. Risk factors for neck nodal metastasis in papillary thyroid micro-carcinoma :a study of 1066patients [ J ] .Clin Endocrinol Metab , 2012 , 97 ( 4 ): 1250-1257. PMid:22319042

    View Article      PubMed/NCBI     
  6. Woodley Niall,Rabbitte Carragh,Clark Louise. Multifocal Micropapillary Thyroid Cancers: Should We Adopt a More Conservative Approach?[J]. British Journal of Surgery,2022,109(Supplement2).

    View Article           
  7. Abdullah Ari M.,Ali Rawa M.,Salih Karzan M.,Mohammed Karukh K.,Kakamad Fahmi H.,Salih Abdulwahid M. Synchronous occurrence of papillary thyroid microcarcinoma, medullary thyroid carcinoma and Hashimoto thyroiditis in a single thyroid: A case report with literature review[J]. International Journal of Surgery Case Reports,2022,93(prepublish):106888. PMid:35318184

    View Article      PubMed/NCBI     
  8. Weng HuaiYu,Yan Ting,Qiu WangWang,Fan YouBen,Yang ZhiLi. The prognosis of skip metastasis in papillary thyroid microcarcinoma is better than that of continuous metastasis.[J]. The Journal of clinical endocrinology and metabolism,2022. PMid:35213704

    View Article      PubMed/NCBI     
  9. Sugitani Iwao. Active surveillance of low-risk papillary thyroid microcarcinoma[J]. Best Practice & Research Clinical Endocrinology & Metabolism,2022(prepublish).;101630. PMid:35256266

    View Article      PubMed/NCBI     
  10. Fernandes Urânia,Pereira Ricardo,Guidi Gonçalo,Vieira Bruno,Marques Rita,Santos Carlos,Pinto-de-Sousa João. Micropapillary thyroid carcinoma: not so harmless as it seems. A 5-year follow-up retrospective study[J]. European Journal of Surgical Oncology,2022,48(2):e120-e120.

    View Article           
  11. Ye Jing,Feng Jia Wei,Wu Wan Xiao,Hu Jun,Hong Li Zhao,Qin An Cheng,Shi Wei Hai,Jiang Yong. Papillary Thyroid Microcarcinoma: A Nomogram Based on Clinical and Ultrasound Features to Improve the Prediction of Lymph Node Metastases in the Central Compartment[J]. Frontiers in Endocrinology,2022,12: 770824-770824. PMid:33995284

    View Article      PubMed/NCBI     
  12. Rangel Leonardo Guimarães,Steck Jose Higino,Volpi Erivelto Martinho,Russell Jonathon O.,Tufano Ralph P.. Radiofrequency Ablation of Papillary Thyroid Microcarcinomas[J]. AACE Clinical Case Reports,2022,8(2): 99-101. PMid:35415224

    View Article      PubMed/NCBI     

Journal Recent Articles