The value of intraoperative frozen tissue pathology in evaluating central lymph node metastasis of papillary thyroid microcarcinoma and risk factors of central lymph node metastasis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 WANG Yajun , KANG Hua , ZHAO Jing , CAI Wei

Clinical Center for Thyroid and Breast Disease, Xuanwu Hospital of Capital Medical University, Beijing 100053, P. R. China;

Corresponding?author：

WANG Yajun, Email: wangyajun@xwhosp.org

Keywords：

papillary thyroid microcarcinoma; central lymph node metastasis; intraoperative pathological examination

DOI：

10.7507/1007-9424.202008003

Video：

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Objective To investigate the role of intraoperative frozen section pathology in central lymph node metastasis of papillary thyroid microcarcinoma (PTMC), and to analyze the risk factors of central lymph node metastasis.Methods Clinical data of 481 patients diagnosed with PTMC from January 2015 to June 2019 in our hospital were included. The consistency of frozen pathological results of intraoperative prelaryngeal lymph nodes, pretracheal lymph nodes, and paratracheal lymph nodes with postoperative paraffin pathological results, as well as the relationship between the numbers of intraoperative lymph nodes sent for examination and postoperative pathological results were analyzed. Then the Kappa value were calculated respectively. Furthermore, univariate and multivariate analysis were used to analyze the factors affecting central lymph node metastasis.Results Central lymph node metastasis was found in 207 patients with PTMC (43.0%). Of the 207 patients, 192 patients were examined by frozen section, with 139 patients had positive results. The Kappa value of prelaryngeal lymph nodes, paratracheal lymph nodes, pretracheal lymph nodes, and central lymph nodes were 0.300, 0.643, 0.560, and 0.755, respectively (P<0.001). Simultaneous intraoperative examination of three anatomic lymph nodes in the central region has a high accuracy in evaluating whether there was lymph node metastasis. The consistency test between intraoperative frozen and postoperative paraffin pathological results showed that when the number of lymph nodes was less than 5, the Kappa value was 0.690 (P<0.001), and when more than or equal to 5, the Kappa value was 0.816 (P<0.001). The results of logistic regression showed that, maximum value of tumor diameter, tumor number, and thyroid capsule involvement were risk factors for central region lymph node metastasis in PTMC (P<0.05).Conclusions Central region lymph node metastasis in PTMC was common. Prelaryngeal lymph nodes, pretracheal lymph nodes, and paratracheal lymph nodes should be selected for frozen pathological examination during the operation, which could effectively indicate whether the central lymph nodes were involved. And combined with the risk factors of lymph node metastasis, such as maximum value of tumor diameter, number of tumors, and thyroid capsule involvement, a more accurate individualized operation plan can be designed for patients.

Citation： WANG Yajun, KANG Hua, ZHAO Jing, CAI Wei. The value of intraoperative frozen tissue pathology in evaluating central lymph node metastasis of papillary thyroid microcarcinoma and risk factors of central lymph node metastasis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(5): 619-624. doi: 10.7507/1007-9424.202008003 Copy

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2.	Weeks KS, Kahl AR, Lynch CF, et al. Racial/ethnic differences in thyroid cancer incidence in the United States, 2007-2014. Cancer, 2018, 124(7): 1483-1491.
3.	Brito JP, Hay ID. Management of papillary thyroid microcarcinoma. Endocrinol Metab Clin North Am, 2019, 48(1): 199-213.
4.	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
5.	Mao Y, Xing M. Recent incidences and differential trends of thyroid cancer in the USA. Endocr Relat Cancer, 2016, 23(4): 313-322.
6.	Dunki-Jacobs E, Grannan K, McDonough S, et al. Clinically unsuspected papillary microcarcinomas of the thyroid: a common finding with favorable biology? Am J Surg, 2012, 203(2): 140-144.
7.	Lee YS, Shin SC, Lim YS, et al. Tumor location-dependent skip lateral cervical lymph node metastasis in papillary thyroid cancer. Head Neck, 2014, 36(6): 887-891.
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11.	中華醫學會內分泌學分會, 中華醫學會外科學分會內分泌學組, 中國抗癌協會頭頸腫瘤專業委員會, 等. 甲狀腺結節和分化型甲狀腺癌診治指南. 中華內分泌代謝雜志, 2012, 28(10): 779-797.
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13.	Kim BY, Choi N, Kim SW, et al. Randomized trial of prophylactic ipsilateral central lymph node dissection in patients with clinically node negative papillary thyroid microcarcinoma. Eur Arch Otorhinolaryngol, 2020, 277(2): 569-576.
14.	Lang BH, Ng SH, Lau LL, et al. A systematic review and meta-analysis of prophylactic central neck dissection on short-term locoregional recurrence in papillary thyroid carcinoma after total thyroidectomy. Thyroid, 2013, 23(9): 1087-1098.
15.	Schneider DF, Chen H, Sippel RS. Impact of lymph node ratio on survival in papillary thyroid cancer. Ann Surg Oncol, 2013, 20(6): 1906-1911.
16.	Amit M, Tam S, Boonsripitayanon M, et al. Association of lymph node density with survival of patients with papillary thyroid cancer. JAMA Otolaryngol Head Neck Surg, 2018, 144(2): 108-114.
17.	Takami H, Sasaki K, Ikeda Y, et al. Detection of sentinel lymph nodes in patients with papillary thyroid cancer. Asian J Surg, 2003, 26(3): 145-148.
18.	Baena Fustegueras JA, González FH, Calderó SG, et al. Magnetic detection of sentinel lymph node in papillary thyroid carcinoma: the MAGIC-PAT study results. Eur J Surg Oncol, 2019, 45(7): 1175-1181.
19.	González ó, Zafon C, Caubet E, et al. Selective sentinel lymph node biopsy in papillary thyroid carcinoma in patients with no preoperative evidence of lymph node metastasis. Endocrinol Diabetes Nutr, 2017, 64(8): 451-455.
20.	王亞軍, 康驊, 滕梁紅, 等. 甲狀腺乳頭狀癌淋巴結轉移特點及危險因素分析. 中國現代手術學雜志, 2019, 23(4): 264-268.
21.	Song CM, Lee DW, Ji YB, et al. Frequency and pattern of central lymph node metastasis in papillary carcinoma of the thyroid isthmus. Head Neck, 2016, 38 Suppl 1: E412-E416.
22.	Sheng L, Shi J, Han B, et al. Predicting factors for central or lateral lymph node metastasis in conventional papillary thyroid microcarcinoma. Am J Surg, 2020, 220(2): 334-340.
23.	解孝章, 鄭炳行, 鄧建偉. 300例cN0甲狀腺微小乳頭狀癌的隨訪研究. 中國普外基礎與臨床雜志, 2020, 27(5): 569-573.
24.	Podnos YD, Smith D, Wagman LD, et al. The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer. Am Surg, 2005, 71(9): 731-734.
25.	Zaydfudim V, Feurer ID, Griffin MR, et al. The impact of lymph node involvement on survival in patients with papillary and follicular thyroid carcinoma. Surgery, 2008, 144(6): 1070-1077.
26.	Ito Y, Miyauchi A, Kihara M, et al. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid, 2014, 24(1): 27-34.

1. Roman BR, Morris LG, Davies L. The thyroid cancer epidemic, 2017 perspective. Curr Opin Endocrinol Diabetes Obes, 2017, 24(5): 332-336.
2. Weeks KS, Kahl AR, Lynch CF, et al. Racial/ethnic differences in thyroid cancer incidence in the United States, 2007-2014. Cancer, 2018, 124(7): 1483-1491.
3. Brito JP, Hay ID. Management of papillary thyroid microcarcinoma. Endocrinol Metab Clin North Am, 2019, 48(1): 199-213.
4. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
5. Mao Y, Xing M. Recent incidences and differential trends of thyroid cancer in the USA. Endocr Relat Cancer, 2016, 23(4): 313-322.
6. Dunki-Jacobs E, Grannan K, McDonough S, et al. Clinically unsuspected papillary microcarcinomas of the thyroid: a common finding with favorable biology? Am J Surg, 2012, 203(2): 140-144.
7. Lee YS, Shin SC, Lim YS, et al. Tumor location-dependent skip lateral cervical lymph node metastasis in papillary thyroid cancer. Head Neck, 2014, 36(6): 887-891.
8. Lim H, Devesa SS, Sosa JA, et al. Trends in thyroid cancer incidence and mortality in the United States, 1974-2013. JAMA, 2017, 317(13): 1338-1348.
9. Park KN, Kang KY, Hong HS, et al. Predictive value of estimated tumor volume measured by ultrasonography for occult central lymph node metastasis in papillary thyroid carcinoma. Ultrasound Med Biol, 2015, 41(11): 2849-2854.
10. Liu LS, Liang J, Li JH, et al. The incidence and risk factors for central lymph node metastasis in cN0 papillary thyroid microcarcinoma: a meta-analysis. Eur Arch Otorhinolaryngol, 2017, 274(3): 1327-1338.
11. 中華醫學會內分泌學分會, 中華醫學會外科學分會內分泌學組, 中國抗癌協會頭頸腫瘤專業委員會, 等. 甲狀腺結節和分化型甲狀腺癌診治指南. 中華內分泌代謝雜志, 2012, 28(10): 779-797.
12. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 2016, 26(1): 1-133.
13. Kim BY, Choi N, Kim SW, et al. Randomized trial of prophylactic ipsilateral central lymph node dissection in patients with clinically node negative papillary thyroid microcarcinoma. Eur Arch Otorhinolaryngol, 2020, 277(2): 569-576.
14. Lang BH, Ng SH, Lau LL, et al. A systematic review and meta-analysis of prophylactic central neck dissection on short-term locoregional recurrence in papillary thyroid carcinoma after total thyroidectomy. Thyroid, 2013, 23(9): 1087-1098.
15. Schneider DF, Chen H, Sippel RS. Impact of lymph node ratio on survival in papillary thyroid cancer. Ann Surg Oncol, 2013, 20(6): 1906-1911.
16. Amit M, Tam S, Boonsripitayanon M, et al. Association of lymph node density with survival of patients with papillary thyroid cancer. JAMA Otolaryngol Head Neck Surg, 2018, 144(2): 108-114.
17. Takami H, Sasaki K, Ikeda Y, et al. Detection of sentinel lymph nodes in patients with papillary thyroid cancer. Asian J Surg, 2003, 26(3): 145-148.
18. Baena Fustegueras JA, González FH, Calderó SG, et al. Magnetic detection of sentinel lymph node in papillary thyroid carcinoma: the MAGIC-PAT study results. Eur J Surg Oncol, 2019, 45(7): 1175-1181.
19. González ó, Zafon C, Caubet E, et al. Selective sentinel lymph node biopsy in papillary thyroid carcinoma in patients with no preoperative evidence of lymph node metastasis. Endocrinol Diabetes Nutr, 2017, 64(8): 451-455.
20. 王亞軍, 康驊, 滕梁紅, 等. 甲狀腺乳頭狀癌淋巴結轉移特點及危險因素分析. 中國現代手術學雜志, 2019, 23(4): 264-268.
21. Song CM, Lee DW, Ji YB, et al. Frequency and pattern of central lymph node metastasis in papillary carcinoma of the thyroid isthmus. Head Neck, 2016, 38 Suppl 1: E412-E416.
22. Sheng L, Shi J, Han B, et al. Predicting factors for central or lateral lymph node metastasis in conventional papillary thyroid microcarcinoma. Am J Surg, 2020, 220(2): 334-340.
23. 解孝章, 鄭炳行, 鄧建偉. 300例cN0甲狀腺微小乳頭狀癌的隨訪研究. 中國普外基礎與臨床雜志, 2020, 27(5): 569-573.
24. Podnos YD, Smith D, Wagman LD, et al. The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer. Am Surg, 2005, 71(9): 731-734.
25. Zaydfudim V, Feurer ID, Griffin MR, et al. The impact of lymph node involvement on survival in patients with papillary and follicular thyroid carcinoma. Surgery, 2008, 144(6): 1070-1077.
26. Ito Y, Miyauchi A, Kihara M, et al. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid, 2014, 24(1): 27-34.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The value of intraoperative frozen tissue pathology in evaluating central lymph node metastasis of papillary thyroid microcarcinoma and risk factors of central lymph node metastasis

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