| Part1Association between multifocality and cervical lymph node metastasis inpapillary thyroid microcarcinoma: a systematic review and meta-analysisStudies have shown multifocality significantly increases lymph node metastasis risk inpapillary thyroid carcinoma, but the association in microcarcinoma is controversial. This isa systematic review and meta-analysis of the role of multifocality in papillary thyroidmicrocarcinoma. A systematic search was performed in databases to identify all originalarticles employing the association between multifocality and lymph node metastasis amongpapillary thyroid microcarcinomas. Eligible studies were carefully reviewed and analyzed.A meta-analysis of fourteen publications with a total3549papillary thyroidmicrocarcinomas demonstrated that multifocality was significantly associated with LNMrisk with an odds ratio of1.7(95%confidence interval,1.1-2.7). Patinets who havemultifocal papillary thyroid microcarcinoma are at high risk of lymph node metastasis.Total thyroidectomy associated with routine central neck dissection may be the best surgicalapproach.Part2Risk for cervical lymph node metastasis among papillary thyroidmicrocarcinomaTo identify high-risk papillary thyroid microcarcinoma (PMC) inclined to lymph nodemetastasis (LNM), we conducted this hospital-based retrospective study. Patients whounderwent total thyroidectomy with central neck dissection and had a pathologicaldiagnosis of PMC between2003and2010at Wuhan Union Hospital were included in thisstudy. The frequency of LNM was retrospectively analyzed according to theclinicopathological features. For multifocal lesions, total tumor diameter was calculated asthe sum of the maximal diameter of each lesion. Age, gender, multifocality, capsularinvasion and local infiltration were independent factors that associated with cervical LNMin PMC. The proportion of LNM was similar between multifocal PMCs with total tumordiameter less than or equal to1cm and unifocal tumors with diameter less than or equal to1cm (37.5vs.30%, P=0.463). LNM frequency was56.89%among multifocal PMC withtotal tumor diameter greater than1cm but less than2cm, and64.9%among unifocaltumors with diameter greater than1cm but less than2cm with no significant difference between the two groups (P=0.330). However, LNM frequency was significantly higher inmultifocal PMCs with total tumor diameter greater than1cm than unifocal tumors withdiameter less than or equal to1cm (60.4vs.30%, P<0.001). Our study indicated that it wasmultifocality along with total tumor diameter that significantly affected LNM risk in PMCpatients.Part3A reliable and easy-to-use scoring system facilitating selection of prophylacticcentral neck dissection among papillary thyroid microcarcinomas based on theretrospective studyNumerous classifications have been developed to determine prognositic factors forpatients with papillary thyroid carcinoma, including the TNM (tumor, node, metastasis)classification by the International Union Against Cancer, the AGES (age, grade, extent, andsize) classification by Mayor’s clinic, and EORTC prognostic index by the EuropeanOrganization for Research and Treatment of Cancer. We conducted this study to providetables that allow thyroid surgeons to easily calculate a thyroid microcarcinoma patient’srisks of cervical lymph node metastasis preoperatively. A combined analysis was carried outof individual patient data from437papillary thyroid microcarcinoma patients whounderwent thyroid surgery for papillary thyroid microcarcinoma during2003-2012inWuhan Union Hospital. A simple scoring system was derived based on5clinical andpathological factors: sex, age, number of tumors, the maximum tumor size, total tumordiameter. The probabilities of developing cervical lymph node metastasis from less than10%to almost100%among groups based on the score. With the scoring system, the urologistcan discuss the different options with the patient to determine the most appropriatetreatment.Part4A reliable and easy-to-use scoring system facilitating selection of prophylacticcentral neck dissection among papillary thyroid microcarcinomas: a prospective studyWe conducted this prospective study to evaluate the above scoring system forpredicting cervical lymph node metastasis among papillary thyroid microcarcinoma. In thisprospecive study, we assessed104patients with papillary thyroid micocarcinoma and todetermine the predictive accuracy of the above scoring system applicable to the study population. With regard to cervical lymph node metastasis, the difference between therespective stages and/or risk groups was highly significant. The probability to developcervical lymph node metastasis among high risk group, namely those scoring more than6was more than90%. However, the probability to develop cervical lymph node metastasisamong middle risk group, namely those scoring more than4but less than6, was around40%. Moreover, among each risk group, the probability to develop cervical lymph nodemetastasis was increased along with increasing score. In conclusion, the scoring system forpredicting cervical lymph node metastasis among papillary thyroid microcarcinoma isreliable and accurate to facilitate thyroid surgeons choosing the most appropriate surgicalprocedure. Moreover, the individual factors such as age, sex, tumor size are easy to obtainand generally available. |
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