Gland surgery · 2026
The influence of clinically suspected metastatic lymph node distribution on occult metastasis and recurrence in papillary thyroid carcinoma.
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Liu Ruiying, Xu Siyuan, Xing Chengwei, Wang Qiuju, Liu Jie
Аннотация
BACKGROUND: According to the current guidelines, at least levels II-IV and VI should be included in therapeutic dissection once a clinical metastasis is identified in papillary thyroid carcinoma (PTC). However, the feasibility of super-selective neck dissection (SSND) has long been a matter of debate. Therefore, this study aimed to evaluate the diagnostic performance of preoperative imaging for detecting lateral neck lymph node metastases (levels II-V) in cN1b PTC patients, characterize their spatial distribution, and analyze the prognostic impact of imaging-detected metastatic patterns.
METHODS: This retrospective study analyzed unilateral cN1b PTC patients who underwent therapeutic lateral neck dissection (levels II-IV, with level V included if clinically involved). Patients were categorized into three groups based on different patterns of clinical metastases: solitary, single-level multiple, and multi-level metastases groups. This study primarily aimed to evaluate the diagnostic performance of preoperative imaging on lymph node metastases, and secondarily to characterize metastatic distribution patterns and analyze their prognostic significance. Diagnostic performance of preoperative imaging was assessed by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Recurrence-free survival (RFS) was assessed using Kaplan-Meier and Cox regression analyses.
RESULTS: A total of 729 patients (497 female, 68.2%) were included. Metastatic burden was highest in levels III-IV, lowest in level V, and displayed a spatially decreasing gradient across adjacent levels. Preoperative imaging demonstrated NPV for occult metastases in level II ranged from 41.0% to 55.8% across subgroups. Over a median follow-up of 52 months, preoperative lymph node metastasis (LNM) patterns were not associated with significantly different 5-year RFS rate (solitary: 91.4% vs. single-level multiple: 90.5% vs. multi-level: 89.5%, P=0.71) or 5-year regional RFS rate (93.0% vs. 91.4% vs. 90.0%, log-rank P=0.67). Adjusted survival analyses showed no independent association between imaging-suspected lymph node distribution and overall or regional recurrence (all P>0.05).
CONCLUSIONS: SSND may be associated with a substantially increased risk of residual occult nodal disease, even in patients with clinically solitary metastasis.
METHODS: This retrospective study analyzed unilateral cN1b PTC patients who underwent therapeutic lateral neck dissection (levels II-IV, with level V included if clinically involved). Patients were categorized into three groups based on different patterns of clinical metastases: solitary, single-level multiple, and multi-level metastases groups. This study primarily aimed to evaluate the diagnostic performance of preoperative imaging on lymph node metastases, and secondarily to characterize metastatic distribution patterns and analyze their prognostic significance. Diagnostic performance of preoperative imaging was assessed by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Recurrence-free survival (RFS) was assessed using Kaplan-Meier and Cox regression analyses.
RESULTS: A total of 729 patients (497 female, 68.2%) were included. Metastatic burden was highest in levels III-IV, lowest in level V, and displayed a spatially decreasing gradient across adjacent levels. Preoperative imaging demonstrated NPV for occult metastases in level II ranged from 41.0% to 55.8% across subgroups. Over a median follow-up of 52 months, preoperative lymph node metastasis (LNM) patterns were not associated with significantly different 5-year RFS rate (solitary: 91.4% vs. single-level multiple: 90.5% vs. multi-level: 89.5%, P=0.71) or 5-year regional RFS rate (93.0% vs. 91.4% vs. 90.0%, log-rank P=0.67). Adjusted survival analyses showed no independent association between imaging-suspected lymph node distribution and overall or regional recurrence (all P>0.05).
CONCLUSIONS: SSND may be associated with a substantially increased risk of residual occult nodal disease, even in patients with clinically solitary metastasis.