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4 - The clinicopathological factors influent on central and lateral neck lymph node metastasis of papillary thyroid carcinoma
Evren Besler, Bülent Çitgez, Nurcihan Aygün, Hakan Mustafa Köksal, Mustafa Fevzi Celayir, Mehmet Mihmanlı, Sıtkı Gürkan Yetkin, Mehmet Uludağ
Objective: Regional lymph node metastases are common in papillary thyroid cancer. In this study we aimed to evaluate the factors affecting central and lateral neck lymph node metastasis in patients with papillary thyroid cancer.
Material and Method: The clinical and pathological findings of 32 patients with papillary thyroid cancer who had undergone total thyroidectomy plus central and lateral compartment dissection were retrospectively analyzed between March 2012 and December 2013. The affect of age, gender, T stage, extrathyroidal extension, multifocality and lymphovascular invasion on central and lateral lymph node metastasis were evaluated.
Results: 12 of patients underwent total thyroidectomy and unilateral central neck dissection, 20 of patients underwent total thyroidectomy and bilateral central neck dissection. 12 of them underwent additional therapeutic unilateral lateral neck dissection. T stage was T1:23, T2:6, T3:3. In twenty patients (62.5%) lymphovascular invasion, in 22 patients (68.5%) multifocality, in 16 patients (50%) extrathyroidal extension were identified. Central lymph node metastasis on 19 of 32 patients (59.4%) and lateral metastasis on 9 of 32 patients (28.1%) were identified. Central neck lymph node metastases were significantly higher in patients with extrathyroidal extention (p<0.05), multifocalitiy (p<0.01), and lymphovascular invasion (p<0.01). Lateral neck lymph node metastases were higher in patients with central neck lymph node metastases (p<0.01).
Conclusion: The neck lymph node metastasis is common and central metastasis occur initially. The occurence risk of central metastasis is higher in patient with extrathyroidal extension, multifocality and lymphvascular invasion. The occurence risk of lateral metastasis is higher in the patients with central metastasis. Although there is no certain clinical and pathological indicator of lymph node metastasis, all patients should be evaluated carefully for lymph node metastasis and extrathyroidal extention radiologically before.
Keywords: Papillary thyroid carcinoma, lymph node metastasis, extrathyroidal extension, multifocality and lymphovascular invasion
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