ASSOCIATION BETWEEN ISTHMIC LOCATION AND INVASIVE FEATURES AND CERVICAL LYMPH NODE METASTASIS IN PATIENTS WITH SOLITARY PAPILLARY THYROID CARCINOMA
Main Article Content
Abstract
Objectives: To describe the clinical and histopathological characteristics of solitary papillary thyroid carcinoma and evaluate the association between isthmic location and features of tumor invasion as well as cervical lymph node metastasis.
Methods: A retrospective cohort study was conducted on 261 patients with solitary papillary thyroid carcinoma who underwent surgery at Thanh Hoa Oncological Hospital between April 2023 and May 2026. Clinical and histopathological data were collected and analyzed for 38 patients with isthmic tumors and 223 patients with lobar tumors.
Results: The rate of capsular invasion was significantly higher in the isthmic group than in the lobar group (44.7% vs. 18.9%, p = 0.0001). After adjustment for age, sex, and tumor size, isthmic location remained independently associated with capsular invasion (adjusted OR = 3.54; 95% CI: 1.70-7.38; p = 0.001). The rate of central lymph node metastasis was 52.6% (20/38 cases) in the isthmic group compared to 48.2% (96/199 cases) in the lobar group (p = 0.620). However, high-volume central lymph node metastasis (> 5 metastatic central lymph nodes) was observed in 18.4% of patients in the isthmic group compared with 6.0% in the lobar group (p = 0.018).
Conclusions: In solitary papillary thyroid carcinoma, isthmic location is independently associated with capsular invasion and correlates with a high burden (> 5 metastatic lympho nodes) of central lymph node metastasis.
Article Details
Keywords
Papillary thyroid carcinoma, isthmus thyroid cancer, cervical lymph node metastasis.
References
[2] Megwalu U.C, Moon P.K. Thyroid cancer incidence and mortality trends in the United States: 2000-2018. Thyroid®, 2022, 32 (5): 560-570. doi: 10.1089/thy.2021.0662
[3] Haugen B.R, Alexander E.K, Bible K.C et al. 2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 2016, 26 (1): 1-133. doi: 10.1089/thy.2015.0020
[4] Trịnh Văn Minh. Giải phẫu đầu mặt cổ. Trong: Giải phẫu người, tập 1. Nhà xuất bản Giáo dục Việt Nam, Vĩnh Phúc, 2010, tr. 451-616.
[5] Won H.S, Han S.H, Oh C.S et al. The location and morphometry of the thyroid isthmus in adult Korean cadavers. Anat Sci Int, 2013, 88 (4): 212-216. doi: 10.1007/s12565-013-0187-9
[6] Lyu Y.S, Pyo J.S, Cho W.J et al. Clinicopathological significance of papillary thyroid carcinoma located in the isthmus: a meta-analysis. World J Surg, 2021, 45 (9): 2759-2768. doi: 10.1007/s00268-021-06178-1
[7] Seok J, Choi J.Y, Yu H.W et al. papillary thyroid cancers of the thyroid isthmus: the pattern of nodal metastasis and the significance of extrathyroidal extension. Ann Surg Oncol, 2020, 27 (6): 1937-1944. doi: 10.1245/s10434-020-08215-0
[8] Kwon O, Lee S, Bae J.S et al. Implications of isthmic location as a risk factor in papillary thyroid carcinoma. Gland Surg, 2023, 12 (7): 952-962. doi: 10.21037/gs-23-56
[9] Lee Y.C, Na S.Y, Chung H et al. Clinicopathologic characteristics and pattern of central lymph node metastasis in papillary thyroid cancer located in the isthmus. The Laryngoscope, 2016, 126 (10): 2419-2421. doi: 10.1002/lary.25926
[10] Song C.M, Lee D.W, Ji Y.B et al. Frequency and pattern of central lymph node metastasis in papillary carcinoma of the thyroid isthmus. Head Neck, 2016, 38 (S1). doi: 10.1002/hed.24009