Lymph Node Metastasis in Papillary Thyroid Carcinoma (PTC)

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Lymph node involvement in PTC:
    • The incidence of nodal metastases in adults depends upon the extent of surgery:
      • Among patients who undergo a modified radical neck dissection:
        • Up to 80% have lymph node metastases:
          • Half of which are microscopic
      • Among patients with papillary micro-carcinomas who have prophylactic central node dissection:
        • Microscopic metastases have been reported in 37% to 64%
    • At diagnosis, clinically detectable regional lymph node metastases:
      • Are more common in children (approximately 50%) than adults (30% to 40%)
  • Invasion of either the thyroid capsule or a lymph node capsule into surrounding soft tissue:
    • Has been reported in 5% to 35% of surgical specimens
  • Vascular invasion is seen in only:
    • Approximately 5% to 10%
  • Distant metastases:
    • From 2% to 10% of patients have metastases beyond the neck at the time of diagnosis:
      • Among such patients:
        • Two-thirds have pulmonary
        • One-fourth have skeletal metastases
        • Rarer sites of metastasis are:
          • The brain, kidneys, liver, and adrenals
  • Growth pattern:
    • The growth pattern and biologic behavior of papillary thyroid cancers are variable:
      • At one end of the spectrum is the common:
        • Micro-carcinoma (formerly called occult papillary thyroid cancer):
          • Defined as a tumor equal or less than 1 cm in diameter
          • These micro-carcinomas are found in 15% to 30% of thyroid glands at autopsy
          • This high frequency, coupled with the rarity of clinically detected papillary cancer:
            • Suggests that the presence of a single focus of micro-carcinoma in a thyroidectomy specimen is likely to be an incidental finding of no clinical importance
      • At the other end of the spectrum is a large, locally invasive cancer with distant metastases noted at the time of diagnosis:
        • These tumors are also far more likely than micro-carcinoma to metastasize through intra-thyroidal lymphatic channels and form multifocal tumors or involve regional lymph nodes
  • References:
    • The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. AU Randolph GW, Duh QY, Heller KS, Livolsi VA, Mandel SJ, Steward DL, Tufano RP, Tuttle For The American Thyroid Association Surgical Affairs Committee’s Taskforce On Thyroid Cancer Nodal Surgery RM SO Thyroid. 2012;22(11):1144

Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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