THYROID
CANCER - PROGNOSTIC SIGNIFICANCE OF LYMPH NODE METASTASES REGARDING RISK OF RECURRENT/PERISTENT
DISEASE
All
patients with differentiated thyroid cancer with locoregional lymph node
metastases were classified as having intermediate risk in the ATA
stratification system. However, the risk of structural (‘anatomic’) disease
recurrence varies significantly from 4 % to 32 %, depending on the extent of
lymphatic dissemination (see table).
|
RISK OF
STRUCTURAL RECURRENCE
|
Extent of
lymphatic dissemination
|
|
4 - 5%
|
Fewer than five (≤ 5) metastatic lymph nodes
All involved lymph nodes < 0.2 cm
|
|
20 %
|
More than five (> 5) involved lymph nodes
|
|
> 21 %
|
More than ten (> 10) involved lymph
nodes
|
|
> 22 %
|
Macroscopic, clinically evident involvement of lymph
nodes (clinical N1 disease)
|
|
27 – 32 %
|
If any metastatic lymph node is > 3 cm
|
Schematically,
patients with lymph node metastases from differentiated thyroid cancer can be
classified into two groups:
·
LOWER RISK N1 DISEASE
(< 5 % risk of recurrence)
o
Fewer
than five (≤ 5) micrometastases (<0.2 cm in largest dimension)
·
HIGHER RISK N1 DISEASE
(> 20 % risk of recurrence)
o
Clinically
detectable (palpable) N1 disease
o
More
than five (> 5) metastatic lymph nodes
o
Any
metastatic lymph node > 3 cm in largest dimension
Extranodal
extension of the tumor through the metastatic lymph node capsule has been
associated with an increased risk of recurrent/permanent disease. It is
difficult to estimate the risk associated with extension of the tumor through
the capsule of the involved lymph node(s) because this histologic finding is
tightly linked with both the number of the involved lymph nodes and invasion of
the tumor through the thyroid capsule
Existing
data are insufficient to determine the risk based on location within the neck,
independent of size/number of involved nodes and extranodal extension.
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