Analysis of prognostic factors for the indication of central lymphadenectomy in papillary thyroid carcinomas

G Chir. 2009 Oct;30(10):404-12.

Abstract

Background: In this study we examined whether it was possible following preoperative parameters statistically significant correlation with the presence of metastatic lymph nodes in the papillary thyroid carcinoma. We conducted a retrospective study in a group of patients with a preoperative diagnosis of papillary carcinoma who underwent total thyroidectomy associated with routine lymphadenectomy of the central compartment (level VI).

Patients and methods: The study group consisted of patients whose definitive histological lymph node examination was positive for metastasis (N1), and the control group comprised patients found negative for metastasis (N0).

Results: Tumour diameter had a significance at 10% level [Pr(>|z|): 0.056], thus indicating that increased tumour size results in a higher probability of being in group N1. The logistic regression revealed that variables with a significance at 5% level for the presence of metastatic lymph nodes in the central compartment (N1) were: sex [Pr(>|z|): 0.019], overall patient age [Pr(>|z|): 0.012] and age >45 [Pr(>|z|): 0.022]. We performed a statistical analysis with the association of three preoperative variables (presence of ultrasound-revealed microcalcifications, presence of solid hypoechogenic nodule and type III vascularisation on echocolour-Doppler); this was found to result in a highly significant probability of entering into group N1.

Conclusions: We found variables statistically significant for the presence of metastatic central compartment lymph nodes, including female sex, age >45 yrs and tumour diameter >1.5 cm. The association of papillary carcinoma with microcalcifications, solid hypoechogenic nodule structure and type III vascularisation on echocolour-Doppler also resulted in a statistically significant increase in the probability of positive level VI lymph nodes.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Carcinoma, Papillary / surgery*
  • Female
  • Humans
  • Lymph Node Excision / methods*
  • Male
  • Middle Aged
  • Prognosis
  • Retrospective Studies
  • Thyroid Neoplasms / surgery*
  • Thyroidectomy
  • Young Adult