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Kee-Hwan Kwon, Eun-Jae Chung, Young-Soo Rho Department of Otolaryngology – Head & Neck Surgery

Patterns And Predictive Factors Of Contralateral Central Nodal Metastasis In Thyroid Papillary Carcinoma : Prospective Study Of Bilateral Central Lymph Node Dissection. Kee-Hwan Kwon, Eun-Jae Chung, Young-Soo Rho Department of Otolaryngology – Head & Neck Surgery

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Kee-Hwan Kwon, Eun-Jae Chung, Young-Soo Rho Department of Otolaryngology – Head & Neck Surgery

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  1. Patterns And Predictive Factors Of Contralateral Central Nodal Metastasis In Thyroid Papillary Carcinoma : Prospective Study Of Bilateral Central Lymph Node Dissection Kee-Hwan Kwon, Eun-Jae Chung, Young-Soo Rho Department of Otolaryngology – Head & Neck Surgery Ilsong Memorial Institute of Head and Neck Cancer Hallym Univeristy Medical Center

  2. Introduction • Prophylactic central lymph node dissection (CLND) • Negatively - higher rate of permanent hypoparathyroidism and permanent nerve injury without evidence of survival benefit or better local control - no additional morbidity as a secondary procedure after local recurrence • Positively - removal of microscopic disease in central lymph nodes may prevent recurrence and improve overall survival without increased morbidity - second operation on recurred central lymph nodes may increase the risk of complications

  3. Introduction • ATA guideline • prophylactic CLND (ipsilateral or bilateral) as an option in the management of advanced PTC (T3 or T4 ) • not for small tumors (T1 or T2 classification), noninvasive or clinically node-negative PTC • Limitations of recent guidelines • even in PTC with small tumors (T1 or T2), there is a high possibility of CLN metastasis, • rates of CLN metastasis are different in accord with various clinicopathologic parameters

  4. Introduction • A few studies have suggested some risk factors for ipsilateral and contralateral CLN metastasis in cases of PTC, but there is no consensus about predictors • Prospective study with histopathologic information and risk factors analysis in PTC patients with clinically only contralateral negative neck nodes

  5. Purpose • The objective of this study was to determine the pattern and the predictive factors for occult contralateral central neck lymph node metastasis, prospectively

  6. Material & Methods • Prospective study • 127 PTC patients with clinically node-negative contralateral central neck • Between 2010 and 2011 • Ilsong Memorial Institute Head and Neck Cancer, Hallym University College of Medicine • Preoperative ultrasonography was performed on every patient

  7. Material & Methods • 16 men, 121 women • mean age: 49.5 years; range 29-76 years • Total thyroidectomy & bilateral CND • Central neck compartment specimens • Dephian • Ipsilateral paratracheal • contralateral paratracheal • Pretracheal

  8. Central neck compartment specimen Delphian pretracheal Rt. paratracheal Lt. paratracheal

  9. Results

  10. Characteristics of patients with PTC

  11. Pattern of lymph node metastasis Delphian :8/ 127 (6.3%) • Central node metastasis :44/ 127 patients (34.6%) • Lateral neck node metastasis : 18/127 patients (14.2%) • Ipsi para + pretracheal : 16/ 127 (12.6%) • Ipsi paratracheal + delphian : 5/ 127 (3.9%) • Ipsi para + pre + delphian : 4/ 127 (3.1%) Pretracheal : 25 (19.7%) Contra Paratracheal : 13/ 127 (10.2%) Ipsi Paratracheal :32/ 127 (25.2%)

  12. Univariate analysis of clinicopathologic characteristics related to contralateral central lymph node metastasis

  13. Multiple logistic regression analysis for contralateral central lymph node metastases

  14. Postoperative complications • Temporary V.palsy 2 (1.5%) • Permanent V.palsy 0 (0%) • Temporary hypoparathyroidism 17 (13.3%) • Permanent hypoparathyroidism 1 (0.8%)

  15. Conclusion • Contralateral central lymph node metastases were significantly associated with age, tumor size, ECS, ipsilateral para/ pretracheal/ delphain and lateral neck compartment node metastasis • On multivariate analysis, lateral neck lymph node metastasis(with young age) was an independent predictive factor of contralateral central compartment metastasis

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