Ultrasound diagnosis of cervical lymph node metastases in patients with first diagnosed papillary thyroid cancer and in patients previously treated surgically and admitted for radioactive iodine therapy

Purpose of the study. To evaluate the potentialities of ultrasound method in diagnosing cervical lymph node metastasis in patients with first diagnosed papillary thyroid cancer (group 1) and in patients previously treated surgically at different clinics of the Russian Federation and subsequently admitted to the A.F.Tsyb Medical Radiological Research Center — Branch of the National Medical Research Radiological Center to receive radioactive iodine therapy (group 2).

Patients and methods. Patients with PTC were divided into two groups. Group 1 included 649 patients with first diagnosed PTC. All the patients underwent thyroidectomy and level VI lymph node neck dissection at the clinic of the A.F.Tsyb Medical Radiological Research Center — Branch of the National Medical Research Radiological Center. Of these patients, 92 patients underwent cervical lymph node dissection including levelsII–III–IV and 9 patients underwent cervical lymph node dissection including level VB. Group 2 consisted of 2875 patients who had previously received surgery at different clinics of the Russian Federation. Subsequently, they were admitted to our institution to receive radioactive iodine therapy. In 291 of these patients, cervical lymph node metastases were found and reoperations were performed: in 89 cases at level VI, in 170 cases at levels II–III–IV and in 32 cases at level VB. The detected metastases were verified histologically.

Results. Histology confirmed the presence of nodal metastasis in 57.6% of 649 patients in group 1, and in 10.1% of 241 patients in group 2. In group 1, the incidence of metastatic disease in level VI nodes was 73% and in group 2, it was 30.6%. Metastases in levels II–III–IV were noted in 24.6% of patients in group 1, and in 58.4% of patients in group 2. Level VB metastasis was found in 2.4% of patients in group 1, and in 11% of patients in group 2. Multiple metastases were detected in 75.4% of patients in group 1, and in 20.3% of patients in group 2.

Conclusion. Central lymph node metastasis was observed in 73% of patients who were first diagnosed with PTC and treated with thyroidectomy and prophylactic level VI cervical lymph node dissection. In group 2, solitary metastases to lateral lymph nodes occurred more frequently after surgical treatment for PTC, which suggested that the primary treatment was insufficiently radical.

1. Paches AI. Head and neck tumors. Clinical manual. Moscow: Practical medicine, Publ., 2013, 478 p. (In Russian).

2. Dzhatin Sha. Surgery and oncology of the head and neck. Transl. ed. by IV. Reshetov. Moscow: T8 Publishing Technologies, Publ., 2016, 838 p. (In Russian).

3. Liu Z, Zeng W, Liu C, Wang S, Xiong Y, Guo Y, et al. Diagnostic accuracy of ultrasonographic features for lymph node metastasis in papillary thyroid microcarcinoma: a single-center retrospective study. World J Surg Oncol. 2017 Jan 26; 15(1):32. https://doi.org/10.1186/s12957–017–1099–2

4. Mizrachi A, Feinmesser R, Bachar G, Hilly O, Cohen M. Value of ultrasound in detecting central compartment lymph node metastases in differentiated thyroid carcinoma. Eur Arch Otorhinolaryngol. 2014 May; 271(5): 1215–1218. https://doi.org/10.1007/s00405–013–2636–4

5. Hwang HS, Orloff LA. Efficacy of preoperative neck ultrasound in the detection of cervical lymph node metastasis from thyroid cancer. Laryngoscope. 2011 Mar; 121(3): 487–491. https://doi.org/10.1002/lary.21227

6. Parshin VS, Tsyb AF, Yamashita S. Thyroid cancer. Ultrasound diagnosis. Clinical atlas (According to Chernobyl materials). Obninsk, 2002, 230 p. (In Russian).

7. Parshin VS, Yamashita S, Tsyb AF. Ultrasound diagnosis of thyroid diseases in Russia. Obninsk–Nagasaki, 2013, 147 p. (In Russian).

8. Lee HS, Roh J L, Gong G, Cho K J, Choi S H, Nam SY, et al. Risk Factors for Re-recurrence After First Reoperative Surgery for Locoregional Recurrent/Persistent Papillary Thyroid Carcinoma. World J Surg. 2015 Aug; 39(8): 1943–1950. https://doi.org/10.1007/s00268–015–3052–2

9. Kim J Y, Jung EJ, Park T, Jeong S H, Jeong C Y, Ju Y T, et al. Impact of tumor size on subclinical central lymph node metastasis in papillary thyroid microcarcinoma depends on age. World J Surg Oncol. 2015 Feb 28; 13: 88. https://doi.org/10.1186/s12957–015–0478–9

10. Kim JW, Roh J L, Gong G, Cho K J, Choi S H, Nam SY, et al. Recurrence in patients with clinically early-stage papillary thyroid carcinoma according to tumor size and surgical extent. Am J Surg. 2016 Sep; 212(3): 419–425.e1. https://doi.org/10.1016/j.amjsurg.2015.12.015

11. Xiang Y, Lin K, Dong S, Qiao LI, He Q, Zhang X. Prediction of central lymph node metastasis in 392 patients with cervical lymph node-negative papillary thyroid carcinoma in Eastern China. Oncol Lett. 2015 Oct; 10(4): 2559–2564. https://doi.org/10.3892/ol.2015.3544

12. Girardi FM, Barra MB, Zettler CG. Predictive factors for lymph node metastasis in solitary papillary thyroid carcinomas: a retrospective study. Pathol Oncol Res. 2015 Jan; 21(1): 59–64. https://doi.org/10.1007/s12253–014–9788–4

13. Onoda N, Ishikawa T, Kawajiri H, Takashima T, Hirakawa K. Pattern of initial metastasisin the cervical lymph node from papillary thyroid carcinoma. Surg Today. 2013 Feb; 43(2): 178– 184. https://doi.org/10.1007/s00595–012–0228–3

14. Hei H, Song Y, Qin J. Individual prediction of lateral neck metastasis risk in patients with unifocal papillary thyroid carcinoma. European Journal of Surgical Oncology. 2019 Jun 1; 45(6): 1039– 1045. https://doi.org/10.1016/j.ejso.2019.02.016

15. Hughes DT, Doherty GM. Central neck dissection for papillary thyroid cancer. Cancer Control. 2011 Apr; 18(2): 83–88. https://doi.org/10.1177/107327481101800202

16. Gong Y, Yang J, Yan S, Su A, Liu F, Gong R, et al. Pattern of and clinicopathologic risk factors for lateral lymph node metastases in papillary thyroid carcinoma patients with lateral cervical lymphadenopathy. Medicine. 2018 Sep; 97(36): e12263. https://doi.org/10.1097/MD.0000000000012263

17. Merdad M, Eskander A, Kroeker T, Freeman JL. Metastatic papillary thyroid cancer with lateral neck disease: pattern of spread by level. Head Neck. 2013 Oct; 35(10): 1439–1442. https://doi.org/10.1002/hed.23149

18. Subramanian S, Lyubaev VL, Brzhezovskii VZh, Aidarbekova AA. Classification of neck lymphnodes: the need for adapting the contemporary classification in oncology practice. JOURNAL of N.N. Blokhin Russian Cancer Research Center. 2006; 17(3): 54– 59. (In Russian).