Poster Presentation ESA-SRB 2023 in conjunction with ENSA

Ultrasonographic features predicting lateral cervical lymph node metastases in patients with papillary thyroid microcarcinoma (#256)

Ho-Cheol Kang 1 2 , Jee Hee Yoon 2 , Ji Yong Park 1 , Hee Kyung Kim 2
  1. Internal Medicine/Endocrinology and metabolism, Chonnam National University Bitgoeul Hospital, Gwangju, South Korea
  2. Chonnam National University Medical School, Gwangju, South Korea

Background: Papillary thyroid microcarcinoma (PTMC) is characterized by its favorable prognosis and potential for active surveillance (AS) as a management option. However, the presence of cervical lymph node (LN) metastasis, especially lateral LN metastasis, significantly impacts management and prognosis. This study aims to identify predictors of lateral LN metastasis by analyzing pre-operative ultrasonographic findings alongside clinicopathological factors.

Methods: A retrospective review of medical records was conducted for PTMC patients who underwent surgery at Chonnam National University Hwasun Hospital between 2004 and 2013. This is a case-control study that compares patients with lateral LN metastasis (N1b) to age and sex-matched patients without LN metastasis (N0).

Results: The study included 90 PTMC patients with N1b and 268 age and sex-matched patients with N0. The mean age was 49.3 years, and females were dominant in both groups. Structural recurrences of 4.4% (4/90) were observed only in the N1b group. The N1b group exhibited a higher frequency of upper lobe tumor location compared to the N0 group (38.9% vs. 16.0%, p<0.001). There was no significant difference in the locations with the presence of invasion to adjacent organs. A higher proportion of non-parallel shape was observed in the N1b group than the N0 group (80.0% vs. 66.0%, p=0.013). There were no differences in echogenicity, sonographic feature, margin, and AP diameter of the thyroid gland between the two groups. In multivariate analysis, independent risk factors for lateral LN metastasis included extra-thyroidal extension, multiplicity, upper lobe tumor location, and non-parallel shape.

Conclusion: Lateral cervical LN metastasis is a significant risk factor for structural recurrence in PTMC patients. Detailed ultrasound examinations, evaluating tumor location, number, orientation, and the presence of ETE, are crucial in accurately predicting lateral LN metastasis. These evaluations can help guide the decision between active surveillance and immediate surgery in PTMC patients.

  1. 1. Ito, Y., et al., An observational trial for papillary thyroid microcarcinoma in Japanese patients. World J Surg, 2010. 34(1): p. 28-35. 2. Jeon, M.J., et al., Features Predictive of Distant Metastasis in Papillary Thyroid Microcarcinomas. Thyroid, 2016. 26(1): p. 161-8.