Role of Lymph Node Dissection in Primary Surgery for Thyroid Cancer

2007 ◽  
Vol 5 (6) ◽  
pp. 623-630 ◽  
Author(s):  
Elizabeth G. Grubbs ◽  
Douglas B. Evans
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Preoperative Evaluation ◽  
Significant Risk ◽  
Cervical Lymphadenopathy ◽  
Operative Management ◽  
Surgical Removal ◽  
Cervical Lymph Nodes ◽  
N0 Neck ◽  
Preoperative Ultrasound

The preoperative evaluation of the clinically N0 neck and the operative management of cervical lymph nodes in patients with papillary and medullary thyroid cancer remains controversial. The appreciation that even patients with low-risk disease have a significant risk for recurrence has generated interest in a more comprehensive preoperative evaluation of the neck and has renewed debate on the extent of lymphadenectomy at the time of thyroidectomy. The authors recommend using preoperative ultrasound before thyroidectomy for all patients with thyroid cancer and before any subsequent surgeries for recurrent disease to identify the extent of lymph node metastases and thereby facilitate complete surgical removal of all gross disease in the neck. The optimal surgical procedure for removing cervical lymphadenopathy is compartment-oriented neck dissection based on the findings from preoperative ultrasound.

scholarly journals Predictors of Regional Lymph Node Recurrence after Initial Thyroidectomy in Patients with Thyroid Cancer

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Amirsina Sharifi ◽  
Abolfazl Shojaeifard ◽  
Ahmadreza Soroush ◽  
Mehdi Jafari ◽  
Ali Ghorbani Abdehgah ◽  
...  
Keyword(s):  
Risk Factors ◽  
Thyroid Cancer ◽  
Lymph Node ◽  
Tumor Size ◽  
Odds Ratio ◽  
Regional Lymph Node ◽  
Significant Risk ◽  
Cervical Lymphadenopathy ◽  
Male Gender ◽  
Lymph Node Recurrence

Background.Regional lymph node recurrence (RLNR) is common in patients with thyroid cancer but clinicopathological predictors are unclear. We aimed to clarify these predictors and identify patients who would benefit from prophylactic lymph node dissection the most.Method.343 patients with different types of thyroid cancer were analyzed retrospectively. All patients underwent total thyroidectomy between 2007 and 2013.Results.The median ± interquartile range of patients’ age was 40 ± 25 years. 245 (71.4%) patients were female. Regarding the risk of regional lymph node recurrence, we found that male gender, age ≥45 years, non-PTC (i.e., medullary, follicular, and anaplastic types) histopathology, T3 (i.e., tumor size >4 cm in the greatest dimension limited to the thyroid or any tumor with minimal extrathyroid extension), stage IVa, and isolated cervical lymphadenopathy as initial manifestation (ICL) are significant risk factors. T3 (p< 0.001; odds ratio = 156.41, 95% CI [55.72–439.1]) and ICL (p< 0.001; odds ratio = 77.79, 95% CI [31.55–191.81]) were the strongest predictors of regional lymph node recurrence.Conclusion.We found easily achievable risk factors for RLNR in thyroid cancers patients. We suggested that patients with specific clinicopathological features like male gender, age ≥45 years, larger tumor size, and extrathyroidal extension be considered as prophylactic lymphadenectomy candidates.

scholarly journals Histomorphological Pattern of Cervical Lymphadenopathy

2013 ◽  
Vol 3 (1) ◽  
pp. 13-17 ◽  
Author(s):  
Md Atiqur Rahman ◽  
Md Mamun Ali Biswas ◽  
Syeda Tasfia Siddika ◽  
Abdul Mannan Sikder
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Hodgkin Lymphoma ◽  
Cervical Lymphadenopathy ◽  
Histological Evaluation ◽  
Cervical Lymph Nodes ◽  
Female Ratio ◽  
Study Results ◽  
Metastatic Neoplasm ◽  
Age And Sex

Background: Enlarged palpable cervical lymph nodes as a primary presenting sign are very common and may be due to inflammatory lesions and tumors. Correlation between clinical findings and laboratory data is essential in arriving at a diagnosis. In patients presenting with cervical lymphadenopathy, excision biopsy provides material to establish an early diagnosis. We designed this study in our population for histological evaluation of cervical lymph node biopsies that might be important in the management of these patients. Objective: Histopathological evaluation of different diseases involving the cervical lymph nodes in relation to age and sex of the study population. Materials and Methods: It was a cross sectional study conducted in the department of Pathology, Enam Medical College & Hospital, Savar, Dhaka during the period from January 2006 to December 2010. A total of 107 patients were evaluated for specific cause of cervical lymphadenopathy in relation to age and sex. Lymph node biopsies of all patients of both sexes and all age groups were included in the study. Results: Among the 107 subjects 58 (54.2%) were males and 49 (45.8%) were females with a male to female ratio of 1.2:1. The age of the patients ranged from 2 to 85 years with a mean age of 32.68 ± 18.01 years. Of the 107 lymph node biopsies, 34 cases (31.8%) were reactive lymphadenitis, 41 cases (38.3%) were tuberculosis, 2 cases (1.9%) were non-caseous granuloma, 6 cases (5.6%) were Hodgkin lymphoma, 8 cases (7.5%) were non-Hodgkin lymphoma, 12 cases (11.2%) were metastatic neoplasm and 4 cases (3.7%) were other specific lesions. Conclusion: The commonest cause of cervical lymphadenopathy was tuberculosis, followed by reactive lymphadenitis, lymphoma and metastatic neoplasm. DOI: http://dx.doi.org/10.3329/jemc.v3i1.13837 J Enam Med Col 2013; 3(1): 13-17

scholarly journals Outcome of Cervical Lymph Nodes Dissection for Thyroid Cancer with Nodal Metastases: A Southeast Asian 3-Year Experience

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Raymond Z. M. Lim ◽  
Juin Y. Ooi ◽  
Jih H. Tan ◽  
Henry C. L. Tan ◽  
Seniyah M. Sikin
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Neck Dissection ◽  
Lymph Node Dissection ◽  
Endocrine Surgery ◽  
Node Dissection ◽  
Referral Centre ◽  
Local Data ◽  
Cervical Lymph Nodes

Introduction. Therapeutic nodal dissection is still the mainstay of treatment for patients with lymph node metastases in many centres. The local data, however, on the outcome of therapeutic LND remains limited. Hence, this study aims to inform practice by presenting the outcomes of LND for thyroid cancer patients and our experience in a tertiary referral centre.Methods. This is a single-centre retrospective observational study in a Malaysian tertiary endocrine surgery referral centre. Patients who underwent total thyroidectomy with lymph node dissection between years 2013 and 2015 were included and electronic medical records over a 3-year follow-up period were reviewed. The outcomes of different lymph node dissection (LND), including central neck dissection, lateral neck dissection, or both, were compared.Results. Of the 43 subjects included, 28 (65.1%) had Stage IV cancer. Among the 43 subjects included, 8 underwent central LND, and 15 had lateral LND while the remaining 20 had dissection of both lateral and central lymph nodes. Locoregional recurrence was found in 16 (37.2%) of our subjects included, with no statistical difference between the central (2/8), lateral (7/15), and both (7/20). Postoperative hypocalcaemia occurred in 7 (16.3%) patients, and vocal cord palsy occurred in 5 (11.6%), whereas 9 patients (20.9%) required reoperation. Death occurred in 4 of our patients.Conclusion. High recurrence and reoperative rates were observed in our centre. While the routine prophylactic LND remains controversial, high risk patients may be considered for prophylactic LND. The long-term risk and benefit of prophylactic LND with individualised patient selection in the local setting deserve further studies.

scholarly journals A Study of FNAC of Cervical Lymph Nodes

1970 ◽  
Vol 7 (1) ◽  
pp. 1-5 ◽  
Author(s):  
G Shakya ◽  
S Malla ◽  
KN Shakya ◽  
R Shrestha
Keyword(s):  
Lymph Node ◽  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Cytology ◽  
Cervical Lymph Node ◽  
Cervical Lymphadenopathy ◽  
Needle Aspiration ◽  
Aspiration Cytology ◽  
Cervical Lymph Nodes ◽  
Fine Needle ◽  
Needle Aspiration Cytology

Background: Fine Needle Aspiration Cytology (FNAC) is a reliable and least expensive method suitable for developing countries like Nepal for the investigation of lymphadenopathy. Knowledge about the pattern of lymphadenopathy is useful in pathological reporting as well as in many clinical settings with diagnostic dilemma. This is a baseline study to investigate the pattern of cervical lymphadenopathy by lymph node FNAC in Nepalese population. Methods: A retrospective study was conducted by critically analyzing the case reports on cervical lymph node FNAC from three years' records (July 2005 to June 2008) at the National Public Health Laboratory, Teku, Kathmandu. Review of all cytological reports were done according to standard guidelines and the diagnosis was classified and correlated with patients' age and ethnicity to explore the pattern and association. Results: Of 508 cervical lymph node FNAC cases, 50.4% was reactive non-specific, 22.4% was tubercular, 4.8 % malignant, 10% chronic granulomatous and the remaining was acute suppurative (12.4%). Highest incidence of malignancy was seen in the fifth decade (50%). Whereas, tubercular lymphadenopathy was found with increasing frequency through childhood (10.5%) and adolescence (21.7%) to young adulthood (30.4%), probably indicative of waning immunity of BCG vaccination. Ethnic groups comprising of Tamang, Sherpa and Bhote had the highest incidence of malignant as well as tubercular lymphadenopathy. Conclusion: The relationship of malignant and tubercular lymphadenopthy with age and ethnicity deserves further study. Efforts at preventing tubercular and early diagnosing malignant lymphadenopathy and reducing morbidity in general will find great usefulness in such associations. Key words: Cervical Lymphadenopathy, Fine Needle Aspiration Cytology, Pattern   DOI: 10.3126/jnhrc.v7i1.2267 Journal of Nepal Health Research Council Vol. 7, No. 1, 2009 April 1-5

scholarly journals Persistent cervical lymphadenitis in a patient with prior thyroid cancer attributed to Kikuchi-Fujimoto disease

2018 ◽  
pp. bcr-2018-226457
Author(s):  
Roman Zuckerman ◽  
Louise Damiani ◽  
Hashem A Ayyad ◽  
Deborah R Alpert
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Lupus Erythematosus ◽  
Cervical Lymphadenopathy ◽  
Needle Aspiration ◽  
Lymph Node Biopsy ◽  
Lymphoproliferative Disease ◽  
Low Grade ◽  
Cervical Lymphadenitis ◽  
Granulomatous Lymphadenitis

We describe a 50-year-old woman with a history of thyroid cancer who presented with bilateral cervical and submandibular lymphadenopathy, low-grade fevers, and increasing fatigue. The patient underwent lymph node fine-needle aspiration, which showed no evidence of metastatic or lymphoproliferative disease. This procedure was complicated by a parapharyngeal abscess and cellulitis. She was treated unsuccessfully with various courses of antibiotics, but briefly responded to short courses of steroids. As her cervical lymphadenopathy returned, she underwent an excisional lymph node biopsy, which demonstrated caseating granulomatous lymphadenitis. Extensive review of systems, physical examination, laboratory and imaging studies demonstrated no evidence of malignancy, infection or systemic lupus erythematosus . Our patient was clinically diagnosed with Kikuchi-Fujimoto disease and successfully treated with prednisone tapered over 3 months. She remains in clinical remission.

scholarly journals Tuberculous Lymphadenitis Mimicking Nodal Metastasis in Follicular Variant Papillary Thyroid Carcinoma

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Marc Gregory Yu ◽  
Jenny Maureen Atun
Keyword(s):  
Lymph Node ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Preoperative Evaluation ◽  
Cervical Lymphadenopathy ◽  
Developed Countries ◽  
Nodal Metastasis ◽  
Tuberculous Lymphadenitis ◽  
Papillary Thyroid ◽  
Follicular Variant

Tuberculous (TB) lymphadenitis can mimic cervical node metastasis from papillary thyroid carcinoma (PTC) since the distribution and appearance of affected lymph nodes are similar. We present the case of an asymptomatic 50-year-old Filipino who sought consult for a gradually enlarging anterior neck mass and a single palpable cervical lymph node. Preoperative workup suggested a thyroid malignancy with nodal metastasis. He underwent total thyroidectomy with node dissection where histopathology confirmed follicular variant- (FV-) PTC. Lymph node examination, however, revealed TB lymphadenitis, and the patient was given standard antimycobacterial therapy. This is the first documented case in Southeast Asia, a high TB burden region. This is also the first report involving FV-PTC, which has features between those of conventional PTC and follicular thyroid carcinoma. The case suggests that, in endemic areas, TB should be a differential in the etiology of cervical lymphadenopathy in PTC patients. In developed countries, this differential diagnosis is also valuable because of the increasing incidence of HIV and TB coinfection. Proper preoperative evaluation is important and needs to be highlighted in the formulation of local guidelines.

scholarly journals LEVELS I–VII FOLLOWING THYROIDECTOMY FOR PAPILLARY THYROID CANCER

2020 ◽  
Vol 19 (5) ◽  
pp. 76-81
Author(s):  
V. S. Parshin ◽  
A. A. Veselova ◽  
V. S. Medvedev ◽  
S. A. Ivanov ◽  
A. D. Kaprin
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Papillary Thyroid Cancer ◽  
Lymph Node Metastases ◽  
Cervical Lymph Node ◽  
Papillary Thyroid ◽  
Cervical Lymph Nodes ◽  
Cervical Lymph Node Metastases ◽  
Node Metastases

Introduction. Cervical lymph node metastases can occur not only in patients when they are first diagnosed with papillary thyroid cancer but also in patients who have undergone thyroidectomy. Objective. The aim of this study was to assess the potential utility of neck ultrasound in diagnosing cervical lymph node metastases (levels I–VII) in patients who underwent surgical treatment for papillary thyroid cancer.Material and Methods. B-mode sonography of all nodal levels in the neck was performed using a linear array transducer in the frequency range of 7.5–13 MHz, power mapping and panoramic scan to locate regional lymph node metastases. All lymph nodes removed during reoperations were submitted for histological evaluation. Sonographic examinations of cervical lymph nodes of the levels I–VII were performed in 2875 patients who had undergone thyroidectomy in different regions of the Russian Federation. The patients were admitted to our clinic to receive radioactive iodine therapy. All neck levels were assessed by ultrasound.Results. Sonography revealed cervical lymph node metastases in 267 (9.2 %) of 2875 patients with papillary thyroid cancer who had undergone thyroidectomy. Nodal metastasis in level VI only occurred in 70 (2.4 %) patients, in levels II–III–IV only in 150 (5.21 %), in level VB only in 32 (1.11 %), and at the same time in level VI and in levels II–III–IV in 15 (0.52 %) patients. There were no metastases in levels I, VA, VII of the neck. Solitary metastases to all levels were found in 7.5 %, multiple metastases in 1.2 %, and conglomerates in 0.6 % of cases. Solitary metastases in level VI were noted in 56 (1.9 %), in levels II–III–IV in 125 (4.3 %), and in level VB in 29 (1.0 %) patients. Multiple metastases in level VI were detected in 11 (0.38 %), in levels II–III–IV in 21 (0.73 %), and in level VB in 3 (0.1 %) patients. Median metastasis size was 2.1 ± 1.6 cm.Conclusion. Post-thyroidectomy patients were found to have cervical lymph node metastases. Ultrasound scanning of the neck should be considered a key examination if there are cicatricial changes as it enables to identify metastasis and to determine its location. The maximal number of metastases was noted in levels II–III–IV. Cervical lymph node metastases occurred less frequently in the central level and level VB. The predominant metastatic pattern was solitary. There was an essential difference in metastatic spread to cervical lymph nodes between postthyroidectomy patients and patients who were first diagnosed with papillary thyroid cancer. 

scholarly journals Aggressive Differentiated Thyroid Cancer due to EML4e13-ALKe20 Fusion: A Case Presentation and Review of the Literature

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Rodhan Khthir ◽  
Zainab Shaheen ◽  
Prasanna Santhanam ◽  
Saroj Sigdel
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Differentiated Thyroid Cancer ◽  
Residual Disease ◽  
Disease Patient ◽  
Clinical Signs ◽  
Cervical Lymphadenopathy ◽  
Rapid Progression ◽  
Anaplastic Lymphoma ◽  
Aggressive Form

Background. Differentiated thyroid cancer (DTC) is an indolent malignancy. It rarely presents with aggressive local invasion and/or distant metastatic disease. Patient findings. We describe a case of a 30-year-old man with a locally aggressive form of papillary thyroid cancer with EML4e13-ALKe20 fusion (EML4: echinoderm microtubule-associated protein-like 4; ALK: anaplastic lymphoma kinase). He presented with right-side cervical lymphadenopathy with a highly suspicious right-side thyroid nodule. Total thyroidectomy and level IV lymph node resection showed extensive bilateral disease, with extrathyroidal and extranodal extension. FDG-PET CT scan following surgery confirmed the presence of significant residual disease in the neck area. He underwent bilateral lateral lymph node dissection followed by radioactive iodine treatment. Somatic mutation testing showed EML4e13-ALKe20 fusion. Summary. This case represents an aggressive form of DTC with EML4e13-ALKe20 fusion. The rapid progression of clinical signs and symptoms and the local extension beyond the thyroid and lymph nodes with the persistence of high-volume local disease after thyroidectomy highlight the aggressive nature of this mutation and the importance of performing genetic analysis to guide future treatments and determine prognosis. Conclusion. This case highlights the importance of using molecular diagnostics in patient care, especially if the presentation is unusual for DTC. A thorough evaluation of the tumor pathology and the somatic mutational profile analysis are important for obtaining vital therapeutic and prognostic guidance.

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