Abstract
Background. The role of lymph node dissection in the treatment of differentiated thyroid carcinoma
remains controversial, and the benefit of therapy is debatable. This study was designed
to identify the precise localization of lymph node micrometastases (LNMM) and map
their cervical involvement in relation with the tumor location within the thyroid
gland. Methods. A total of 2551 cervical lymph nodes were obtained from 80 patients with well-differentiated
thyroid cancer. They were diagnosed as clear lymph nodes by hematoxylin and eosin
stain and then examined immunohistochemically with cytokeratins (AE1/AE3) for evidence
of micrometastases. Results. Forty-two patients out of 80 (53%) had LNMM. Forty-eight patients (60%) had the tumor
confined to only one third of 1 of the 2 lobes of the thyroid gland or isthmus. The
frequencies and locations of LNMM in patients were 50% (3/6) in the deep upper cervical
nodes, with tumors localized in the upper third; 31% (5/16) in the paraglandular nodes,
with tumors affecting the middle third; 63% (12/19) in the paratracheal nodes, with
tumors affecting the lower third of the thyroid lobe; and 71% (5/7) in the pretracheal
nodes in the isthmus-located tumor. All the LNMM occurred on the ipsilateral side
of the tumor. Conclusions. When thyroid carcinoma is located in the upper third of the thyroid lobe, the LNMM
are found in the direction of upward lymphatic flow. When the tumor is located in
the lower third or isthmus, LNMM are directed downward. In addition, early thyroid
carcinoma micrometastases do not cross the midline but remain on the ipsilateral side
of the tumor. (Surgery 2002;131:249-56).
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The value of lymph-node dissection in patients with differentiated thyroid cancer.Surg Clin North Am. 1987; 67: 251-261
- Long-term results and prognostic factors in patients with differentiated thyroid carcinoma.Cancer. 1985; 55: 794-808
- Papillary thyroid carcinoma: a 10 year follow-up report of the impact of therapy in 576 patients.Am J Med. 1981; 70: 511-518
- Prospective management of nodal metastases in differentiated thyroid cancer.Am J Surg. 1991; 162: 353-356
- Significance of lymph node metastases in differentiated thyroid cancer.Am J Surg. 1978; 136: 107-112
- Papillary and follicular thyroid cancer-prognostic factors in 1578 patients.Am J Med. 1987; 83: 479-488
- Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer.Am J Med. 1994; 97: 418-428
- Natural history, treatment, and course of papillary thyroid carcinoma.J Clin Endocrinol Metab. 1990; 71: 414-424
- Prognostic factors and risk group analysis in follicular carcinoma of the thyroid.Surgery. 1995; 118: 1131-1138
- The results of various modalities of treatment of well-differentiated thyroid carcinoma: a retrospective review of 1599 patients.J Clin Endocrinol Metab. 1992; 75: 714-720
- On the significance of lymph-node metastases of differentiated thyroid carcinoma and patient survival (a quantitative approach by meta-analysis and multivariate analysis of retrospective studies).Exp Clin Endocrinol. 1993; 101: 118-123
- Prognostic significance of cervical lymph node metastases in differentiated thyroid cancer.Am J Surg. 1992; 164: 578-581
- Papillary thyroid cancer treated at the Mayo Clinic, 1946 through 1970: initial manifestations, pathologic findings, therapy, and outcome.Mayo Clin Proc. 1986; 61: 978-996
- Prognostic factors in patients dying of well-differentiated thyroid cancer.Arch Otolaryngol Head Neck Surg. 1989; 115: 326-330
- Risk factor analysis in differentiated thyroid cancer.Cancer. 1979; 43: 810-820
- Differentiated thyroid cancer: outcome of treatment in 80 cases.Ann Acad Med Singapore. 1990; 19: 435-438
- Papillary carcinoma of the thyroid. A clinicopathologic study of 241 cases treated at the University of Florence, Italy.Cancer. 1985; 55: 805-828
- Multifactorial study of prognostic factors in differentiated thyroid carcinoma and a re-evaluation of the importance of age.Br J Surg. 1986; 73: 274-277
- Practical aspects of thyroid disease.in: : Chugai-Igaku, Tokyo1977: 345
- Subtotal thyroidectomy and modified radical neck dissection for thyroid cancer.Surgery. 1982; 6: 603-607
- Modified neck dissection in treatment of thyroid cancer: a safe procedure.Eur J Cancer Clin Oncol. 1988; 24: 315-324
- Papillary carcinoma of the thyroid I. Developing pattern of metastasis.Cancer. 1970; 26: 1053-1060
- Sentinel lymphadenectomy in thyroid malignant neoplasms.Arch Surg. 1998; 133: 288-292
- Lymphatic mapping and sentinel lymphadenectomy for breast cancer.Ann Surg. 1994; 220: 391-401
- Management of early-stage melanoma by intraoperative lymphatic mapping and selective lymphadenectomy: an alternative to routine elective lymphadenectomy or “watch and wait”.Surg Oncol Clin North Am. 1992; 1: 247-259
- Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer.World J Surg. 1994; 18: 559-568
- Comparison of keratin monoclonal antibodies MAK-6, AE1:AE3, and CAM-5.2.Am J Clin Pathol. 1987; 88: 297-301
- Cytokeratin immunoreactive cells of human lymph nodes and spleen in normal and pathological conditions. An immunocytochemical study.Virchows Arch. 1990; 416: 479-490
- Use of avidin-biotin-peroxidase complex (ABC) in immunoperoxidase techniques: a comparison between ABC and unlabeled antibody (PAP) procedures.J Histochem Cytochem. 1981; 29: 577-578
- General Rules for the Description of Thyroid Cancer.5th ed. : Kanehara, Tokyo1996
- Regional lymph node metastases in well-differentiated thyroid carcinoma.Int Surg. 1987; 72: 100-103
- Current management of thyroid cancer.Adv Surgery. 1995; 28: 191-221
- Papillary thyroid carcinoma: rationale for total thyroidectomy.in: Textbook of Endocrine Surgery. : W.B. Saunders, Philadelphia1997: 90-93
- Surgical considerations and approach to thyroid cancer.Endocrinol Metab Clin North Am. 1996; 25: 115-139
- Predictors of thyroid tumor aggressiveness.West J Med. 1996; 165: 131-138
- Low-risk differentiated thyroid cancer: the need for selective treatment.Ann Surg Oncol. 1997; 4: 328-333
- Current results of conservative surgery for differentiated thyroid carcinoma.World J Surg. 1986; 10: 612-622
- Papillary thyroid carcinoma. Morphology and prognosis.Virchows Arch. 1982; 396: 19-39
- Papillary thyroid carcinoma: Recurrence in the thyroid gland after initial surgical treatment.Am J Surg. 1963; 106: 728-734
- Thyroid carcinoma with cervical metastasis: effectiveness of total thyroidectomy and node excision.Am J Surg. 1971; 122: 458-463
- Clinicopathological studies of minimal thyroid and ordinary thyroid cancers.Jpn J Surg. 1984; 13: 110-117
- Bilateral cervical lymph node metastases in well-differentiated thyroid cancer.Arch Surg. 1990; 125: 804-806
- Papillary thyroid carcinoma.Endocrinol Metab Clin North Am. 1990; 19: 545-576
- Observation and therapeutic dissection for the clinically negative neck in differentiated thyroid carcinoma.Surgery. 1996; 58: 1375-1377
- Lymph node dissection in papillary thyroid carcinoma.Operation. 1994; 48: 157-164
- Incidence of regional recurrence guiding radicality in differentiated thyroid carcinoma.World J Surg. 1996; 20: 860-866
- Lymph node metastases from well-differentiated thyroid cancer.Am J Surg. 1985; 149: 610-612
- Localization of cervical node metastasis of papillary thyroid carcinoma.World J Surg. 1999; 23: 970-974
- Thyroid carcinoma: current controversies.Curr Prob Surg. 1978; 15: 1-67
Article info
Publication history
Accepted:
September 22,
2001
Footnotes
*This study was supported in part by grants-in-aid for scientific research from the Ministry of Education, Science, and Culture, Japan.
**Reprint requests: Shizuo Nakano, MD, First Department of Surgery, Kagoshima University, School of Medicine, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
Identification
Copyright
© 2002 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
