Background: Thyroidectomy with only limited examination of lymph nodes is considered to pose potential risk for harboring occult nodal disease in patients with papillary thyroid cancer (PTC). However, the optimal number of examined lymph nodes (ELNs) in patients with PTC with clinically lateral lymph node metastasis (cN1b) remains unclear.
Patients And Methods: Patients with cN1b PTC who underwent therapeutic neck dissection were retrospectively enrolled. A β-binomial distribution was utilized to calculate the likelihood of occult nodal disease as a function of total number of ELNs, and recurrence-free survival analysis was performed using the Kaplan-Meier method.
Results: Together 982 patients met the inclusion criteria for this study, of which 853 patients had node-positive disease. The median ELN count was 23 (interquartile range 14-33). Increased ELN counts were associated with a decreased rate of occult nodal disease. The prevalence of nodal metastasis was 84%, while the corrected prevalence was 90%. The estimated probability of false-negative nodal disease was 67% for patients with PTC when only a single node was examined. Survival analysis revealed that populations with higher probability of occult nodal diseases experienced significantly higher recurrence rate. For patient with cN1b PTC, 20 ELNs were required to achieve 95% confidence of having no occult nodal disease. Minimum thresholds of 24, 14, 14, and 15 ELNs were selected for patients with pT1, pT2, pT3, and pT4 diseases, respectively.
Conclusions: Our findings robustly conclude that a minimum of 20 ELNs is essential to assess the quality of neck dissection and acquire accurate staging for patients with cN1b PTC.
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http://dx.doi.org/10.1245/s10434-024-16391-6 | DOI Listing |
Int J Clin Oncol
December 2024
Department of Surgical Oncology, National Cancer Institute, Cairo University, Kasr Al Eini St., Fom El Khalig Sq., P.C. 11796, Cairo, Egypt.
Background And Objective: Lymph node metastasis (LNM) in soft tissue sarcoma (STS) of the extremities is relatively rare. We aimed to evaluate the prognosis and the survival of patients with LNM and correlate them to the pattern of metastasis.
Methods: A retrospective study of patients diagnosed with STS of the extremities from 2015 to 2019.
World J Surg
December 2024
UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
World J Surg
December 2024
Monash University Endocrine Surgery Unit, Alfred Health, Melbourne, VIC, Australia.
Background: For small papillary thyroid cancers (PTCs) with no lateral nodal involvement, American Thyroid Association guidelines recommend performing prophylactic central lymph node dissection (pCLND) if it influences further management. Our cohort study explored to what extent performing pCLND for small PTCs can de-escalate subsequent therapy including completion thyroidectomy and adjuvant radioactive iodine (RAI) ablation.
Methods: Adults with T1, T2, and cN0 PTCs were identified from 42 centers across the prospectively maintained Australian and New Zealand Thyroid Cancer Registry (ANZTCR) between 2017 and 2023.
Indian J Otolaryngol Head Neck Surg
December 2024
Department of Head & Neck Surgery, Dr B Borooah Cancer Institute, Flat No: B5, Guwahati, Assam, 781016 India.
Squamous cell carcinoma of the oral cavity is the most common malignancy of head and neck cancer in India. With nodal dissemination, there is a significant decrease in survival. This study is aimed at studying the impact of occult metastasis on an estimated overall survival in clinically N0 patients post neck dissection.
View Article and Find Full Text PDFEndocrine
November 2024
UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Purpose: In absence of nodal metastases or aggressive features, thyroid lobectomy (TL) should be preferred over total thyroidectomy (TT) for 1-4 cm unifocal, papillary thyroid carcinoma (PTC). However, occult, despite non-microscopic (≥2 mm), nodal metastases may be present in clinically node-negative (cN0) PTC.
Methods: Among 4216 thyroidectomies for malignancy (2014-2023), 110 TL plus ipsilateral central neck dissection (I-CND) were scheduled for unifocal cT1b/small cT2 (≤3 cm) cN0 PTCs.
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