Cervical Lymph Node Metastases of Papillary Thyroid Carcinoma, in the Central and Lateral Compartments, in Children and Adolescents: Predictive Factors

C Spinelli, F Tognetti, S Strambi, R Morganti, M Massimino, P Collini

Research output: Contribution to journalArticle

Abstract

PROBLEM STATEMENT: The aim of our study was to identify predictive factors for lymph node metastases (LNM) in children and adolescents with papillary thyroid carcinoma (PTC) and their impact on survival.

METHODS: The authors conducted an Italian multicentric retrospective analysis on 132 pediatric patients (0-18 years old) affected by PTC between 2000 and 2014. The investigated variables were demographic characteristics of the patients, clinicopathological features of PTCs, and persistence/recurrence of disease. The female/male ratio was 3.1:1. The median age was 14.3 ± 3.5 years (range 4-18 years). Total thyroidectomy was performed in all the patients, followed by lymph node dissection in 87 patients (65.9%). Metastatic lymph node involvement was confirmed in 73 patients (55.3%): lateral compartment (LC) in 25 patients (34.2%), central compartment (CC) in 17 patients (23.3%), and both compartments in 31 patients (42.5%).

RESULTS: Multifocality (P < .00), vascular invasion (P = .04), infiltration of the thyroid capsule (P < .00), minimal extrathyroidal extension (P < .00), diffuse sclerosing variant of PTC (P = .02), and presence of LNM in the LC (P < .00) were significantly associated with LNM in CC. Infiltration of the thyroid capsule (P < .00), massive extrathyroidal extension (P = .03), distant metastases (P = .02), PTC, not otherwise specified (P < .00), and presence of LNM in the CC (P < .00) were significantly associated with LNM in LC. Age, sex and size of PTC were not correlated with the presence of cervical LNM. Moreover, presence of LNM in CC increases the risk of persistence (P < .01) and recurrence (P < .02) of PTC in children and adolescents.

CONCLUSIONS: Most predictors, unfortunately, are only identified post-operatively by histopathologic examination: Just a small part of them can be pre-operatively detected with a low-sensitivity neck ultrasonography. In PTC patients with pre-operative predictors, we suggest an accurate pre- and intra-operative evaluation of CC and/or LC to find suspicious lymph nodes. The presence of LNM in CC has an impact on disease/progression/relapse-free survival. We suggest performing RAI therapy and an accurate follow-up for pediatric patients with only post-operative predictors.

Original languageEnglish
Pages (from-to)2444-2453
Number of pages10
JournalWorld Journal of Surgery
Volume42
Issue number8
DOIs
Publication statusPublished - Aug 2018

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Lymph Nodes
Neoplasm Metastasis
Recurrence
Capsules
Thyroid Gland
Papillary Thyroid cancer
Pediatrics
Factor IX
Thyroidectomy
Lymph Node Excision
Disease-Free Survival
Blood Vessels
Disease Progression
Ultrasonography
Neck
Demography
Survival

Keywords

  • Adolescent
  • Carcinoma, Papillary/diagnostic imaging
  • Child
  • Child, Preschool
  • Disease-Free Survival
  • Female
  • Humans
  • Lymph Node Excision
  • Lymph Nodes/diagnostic imaging
  • Lymphatic Metastasis
  • Male
  • Neck/diagnostic imaging
  • Neoplasm Recurrence, Local/pathology
  • Prognosis
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • Sex Distribution
  • Thyroid Neoplasms/diagnostic imaging
  • Thyroidectomy
  • Ultrasonography

Cite this

@article{408495ac58284650a17da2ae2a61f363,
title = "Cervical Lymph Node Metastases of Papillary Thyroid Carcinoma, in the Central and Lateral Compartments, in Children and Adolescents: Predictive Factors",
abstract = "PROBLEM STATEMENT: The aim of our study was to identify predictive factors for lymph node metastases (LNM) in children and adolescents with papillary thyroid carcinoma (PTC) and their impact on survival.METHODS: The authors conducted an Italian multicentric retrospective analysis on 132 pediatric patients (0-18 years old) affected by PTC between 2000 and 2014. The investigated variables were demographic characteristics of the patients, clinicopathological features of PTCs, and persistence/recurrence of disease. The female/male ratio was 3.1:1. The median age was 14.3 ± 3.5 years (range 4-18 years). Total thyroidectomy was performed in all the patients, followed by lymph node dissection in 87 patients (65.9{\%}). Metastatic lymph node involvement was confirmed in 73 patients (55.3{\%}): lateral compartment (LC) in 25 patients (34.2{\%}), central compartment (CC) in 17 patients (23.3{\%}), and both compartments in 31 patients (42.5{\%}).RESULTS: Multifocality (P < .00), vascular invasion (P = .04), infiltration of the thyroid capsule (P < .00), minimal extrathyroidal extension (P < .00), diffuse sclerosing variant of PTC (P = .02), and presence of LNM in the LC (P < .00) were significantly associated with LNM in CC. Infiltration of the thyroid capsule (P < .00), massive extrathyroidal extension (P = .03), distant metastases (P = .02), PTC, not otherwise specified (P < .00), and presence of LNM in the CC (P < .00) were significantly associated with LNM in LC. Age, sex and size of PTC were not correlated with the presence of cervical LNM. Moreover, presence of LNM in CC increases the risk of persistence (P < .01) and recurrence (P < .02) of PTC in children and adolescents.CONCLUSIONS: Most predictors, unfortunately, are only identified post-operatively by histopathologic examination: Just a small part of them can be pre-operatively detected with a low-sensitivity neck ultrasonography. In PTC patients with pre-operative predictors, we suggest an accurate pre- and intra-operative evaluation of CC and/or LC to find suspicious lymph nodes. The presence of LNM in CC has an impact on disease/progression/relapse-free survival. We suggest performing RAI therapy and an accurate follow-up for pediatric patients with only post-operative predictors.",
keywords = "Adolescent, Carcinoma, Papillary/diagnostic imaging, Child, Child, Preschool, Disease-Free Survival, Female, Humans, Lymph Node Excision, Lymph Nodes/diagnostic imaging, Lymphatic Metastasis, Male, Neck/diagnostic imaging, Neoplasm Recurrence, Local/pathology, Prognosis, Proportional Hazards Models, Retrospective Studies, Risk Factors, Sex Distribution, Thyroid Neoplasms/diagnostic imaging, Thyroidectomy, Ultrasonography",
author = "C Spinelli and F Tognetti and S Strambi and R Morganti and M Massimino and P Collini",
year = "2018",
month = "8",
doi = "10.1007/s00268-018-4487-z",
language = "English",
volume = "42",
pages = "2444--2453",
journal = "World Journal of Surgery",
issn = "0364-2313",
publisher = "Springer New York",
number = "8",

}

TY - JOUR

T1 - Cervical Lymph Node Metastases of Papillary Thyroid Carcinoma, in the Central and Lateral Compartments, in Children and Adolescents

T2 - Predictive Factors

AU - Spinelli, C

AU - Tognetti, F

AU - Strambi, S

AU - Morganti, R

AU - Massimino, M

AU - Collini, P

PY - 2018/8

Y1 - 2018/8

N2 - PROBLEM STATEMENT: The aim of our study was to identify predictive factors for lymph node metastases (LNM) in children and adolescents with papillary thyroid carcinoma (PTC) and their impact on survival.METHODS: The authors conducted an Italian multicentric retrospective analysis on 132 pediatric patients (0-18 years old) affected by PTC between 2000 and 2014. The investigated variables were demographic characteristics of the patients, clinicopathological features of PTCs, and persistence/recurrence of disease. The female/male ratio was 3.1:1. The median age was 14.3 ± 3.5 years (range 4-18 years). Total thyroidectomy was performed in all the patients, followed by lymph node dissection in 87 patients (65.9%). Metastatic lymph node involvement was confirmed in 73 patients (55.3%): lateral compartment (LC) in 25 patients (34.2%), central compartment (CC) in 17 patients (23.3%), and both compartments in 31 patients (42.5%).RESULTS: Multifocality (P < .00), vascular invasion (P = .04), infiltration of the thyroid capsule (P < .00), minimal extrathyroidal extension (P < .00), diffuse sclerosing variant of PTC (P = .02), and presence of LNM in the LC (P < .00) were significantly associated with LNM in CC. Infiltration of the thyroid capsule (P < .00), massive extrathyroidal extension (P = .03), distant metastases (P = .02), PTC, not otherwise specified (P < .00), and presence of LNM in the CC (P < .00) were significantly associated with LNM in LC. Age, sex and size of PTC were not correlated with the presence of cervical LNM. Moreover, presence of LNM in CC increases the risk of persistence (P < .01) and recurrence (P < .02) of PTC in children and adolescents.CONCLUSIONS: Most predictors, unfortunately, are only identified post-operatively by histopathologic examination: Just a small part of them can be pre-operatively detected with a low-sensitivity neck ultrasonography. In PTC patients with pre-operative predictors, we suggest an accurate pre- and intra-operative evaluation of CC and/or LC to find suspicious lymph nodes. The presence of LNM in CC has an impact on disease/progression/relapse-free survival. We suggest performing RAI therapy and an accurate follow-up for pediatric patients with only post-operative predictors.

AB - PROBLEM STATEMENT: The aim of our study was to identify predictive factors for lymph node metastases (LNM) in children and adolescents with papillary thyroid carcinoma (PTC) and their impact on survival.METHODS: The authors conducted an Italian multicentric retrospective analysis on 132 pediatric patients (0-18 years old) affected by PTC between 2000 and 2014. The investigated variables were demographic characteristics of the patients, clinicopathological features of PTCs, and persistence/recurrence of disease. The female/male ratio was 3.1:1. The median age was 14.3 ± 3.5 years (range 4-18 years). Total thyroidectomy was performed in all the patients, followed by lymph node dissection in 87 patients (65.9%). Metastatic lymph node involvement was confirmed in 73 patients (55.3%): lateral compartment (LC) in 25 patients (34.2%), central compartment (CC) in 17 patients (23.3%), and both compartments in 31 patients (42.5%).RESULTS: Multifocality (P < .00), vascular invasion (P = .04), infiltration of the thyroid capsule (P < .00), minimal extrathyroidal extension (P < .00), diffuse sclerosing variant of PTC (P = .02), and presence of LNM in the LC (P < .00) were significantly associated with LNM in CC. Infiltration of the thyroid capsule (P < .00), massive extrathyroidal extension (P = .03), distant metastases (P = .02), PTC, not otherwise specified (P < .00), and presence of LNM in the CC (P < .00) were significantly associated with LNM in LC. Age, sex and size of PTC were not correlated with the presence of cervical LNM. Moreover, presence of LNM in CC increases the risk of persistence (P < .01) and recurrence (P < .02) of PTC in children and adolescents.CONCLUSIONS: Most predictors, unfortunately, are only identified post-operatively by histopathologic examination: Just a small part of them can be pre-operatively detected with a low-sensitivity neck ultrasonography. In PTC patients with pre-operative predictors, we suggest an accurate pre- and intra-operative evaluation of CC and/or LC to find suspicious lymph nodes. The presence of LNM in CC has an impact on disease/progression/relapse-free survival. We suggest performing RAI therapy and an accurate follow-up for pediatric patients with only post-operative predictors.

KW - Adolescent

KW - Carcinoma, Papillary/diagnostic imaging

KW - Child

KW - Child, Preschool

KW - Disease-Free Survival

KW - Female

KW - Humans

KW - Lymph Node Excision

KW - Lymph Nodes/diagnostic imaging

KW - Lymphatic Metastasis

KW - Male

KW - Neck/diagnostic imaging

KW - Neoplasm Recurrence, Local/pathology

KW - Prognosis

KW - Proportional Hazards Models

KW - Retrospective Studies

KW - Risk Factors

KW - Sex Distribution

KW - Thyroid Neoplasms/diagnostic imaging

KW - Thyroidectomy

KW - Ultrasonography

U2 - 10.1007/s00268-018-4487-z

DO - 10.1007/s00268-018-4487-z

M3 - Article

C2 - 29383423

VL - 42

SP - 2444

EP - 2453

JO - World Journal of Surgery

JF - World Journal of Surgery

SN - 0364-2313

IS - 8

ER -