OBJECTIVEWell differentiated thyroid carcinoma (WDTC) may be located in the isthmus. The guidelines now have not mentioned an appropriate procedure for WDTC in the isthmus. The aim of this study was to retrospectively analyze the outcomes in patients with WDTC in the isthmus treated at our institution.

METHODSTwenty-seven patients with WDTC in the isthmus were managed by surgery in the Cancer Hospital of Chinese Academy of Medical Sciences from 1985-2006. Their demographic data, surgical procedures, pathological features, stages and outcomes were analyzed.

RESULTSFive patients were men and 22 were women. The median age was 41 (range, 20-69) years. Nine patients received isthmusectomy, fourteen patients received extended isthmusectomy and four received isthmusectomy with unilateral lobectomy. There were no complications of recurrent laryngeal nerve palsy or hypocalcaemia. The median size of lesion was 1.0 cm(range, 0.5-4.0 cm). Sixteen patients had a pathologically T1a lesion (pT1a), seven patients were pT1b, two patients were pT2 and two pT3. Three patients had papillary carcinoma detected in perithyroid lymph nodes (pN1a). Among the 27 cases, 25 patients had a solitary malignant nodule confined to the isthmus, one had two malignant nodules confined to the isthmus and one had two malignant nodules located separately in the isthmus and right lobe. The patients were followed up with a median follow-up time of 85 months(range, 37-274 months). The 5-year recurrence-free survival was 95.2% and overall survival rate was 100%.

CONCLUSIONSOur results suggest that isthmusectomy or extended isthmusectomy are feasible and efficient for the patients with WDTC located in the isthmus, and concurrent pretracheal lymph node dissection should be considered.

Adult ; Aged ; Carcinoma, Papillary ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; surgery ; Neoplasm Staging ; Retrospective Studies ; Survival Rate ; Thyroid Gland ; pathology ; surgery ; Thyroid Neoplasms ; pathology ; surgery ; Thyroidectomy ; methods ; Tumor Burden ; Young Adult

OBJECTIVETo retrospectively analyze the long-term results of prophylactic central lymph node dissection in cN0 papillary thyroid carcinoma (PTC), and investigate the treatment method of the cervical lymph nodes for cN0 PTC.

METHODSOne hundred and thirty-six patients with cN0 PTC were treated by surgery at the Cancer Hospital of Chinese Academy of Medical Sciences from 2000 to 2006. Their clinicopathological characteristics, surgical procedures and survival outcomes were collected and analyzed.

RESULTSThe occult lymph node metastasis rate in central compartment was 61.0%. The average number of positive lymph nodes was 2.47 (1-13), in which 54 patients had 1-2 and 29 patients had ≥ 3 positive lymph nodes. Multiple logistic regression analysis showed that age less than 45 (P=0.001, OR 3.571, 95% CI 1.681-7.587)and extracapsular spread (ECS) (P=0.015, OR 2.99, 95% CI 1.241-7.202)were independent risk factors for lymph node metastasis in the central compartment. The ten-year cumulative overall survival rate was 98.3% and cumulative lateral neck metastasis rate was 25.2%. Multivariate analysis with Cox regression model showed that ECS (P=0.001, OR 5.211, 95% CI1.884-14.411) and positive lymph nodes in the central compartment ≥ 3 (P=0.009, OR 4.005, 95% CI 1.419-11.307) were independent risk factors for lymph node recurrence in the lateral neck region. The distribution of recurrent lymph nodes: level IV (82.4%), level III (64.7%), level II (29.4%) and level V (11.8%).

CONCLUSIONSRoutine central lymph node dissection, at least unilateral, should be conducted for cN0 papillary thyroid carcinoma. Attention should be paid to the treatment of lateral neck region in patients with cN0 papillary thyroid carcinoma. Selective neck dissection is suggested for cN0 PTC with ECS or positive central lymph nodes ≥ 3, or both. The range of dissection should include level III and IV at least.

Carcinoma ; pathology ; Carcinoma, Papillary ; Female ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Multivariate Analysis ; Neck ; Neck Dissection ; methods ; Neoplasm Recurrence, Local ; pathology ; Regression Analysis ; Retrospective Studies ; Risk Factors ; Thyroid Neoplasms ; pathology