Preoperative Prediction of Metastatic Lymph Nodes Posterior to the Right Recurrent Laryngeal Nerve in cN0 Papillary Thyroid Carcinoma

Jun Shao; Xiya Wang; Haiyuan Yu; Wei Ding; Bin Xu; Dongsheng Ma; Xuechun Huang; Hongqing Yin

doi:10.2147/CMAR.S454607

Preoperative Prediction of Metastatic Lymph Nodes Posterior to the Right Recurrent Laryngeal Nerve in cN0 Papillary Thyroid Carcinoma

Cancer Manag Res. 2024 May 6:16:421-429. doi: 10.2147/CMAR.S454607. eCollection 2024.

Authors

Jun Shao¹, Xiya Wang¹, Haiyuan Yu¹, Wei Ding¹, Bin Xu¹, Dongsheng Ma¹, Xuechun Huang², Hongqing Yin¹

Affiliations

¹ Department of Medical Ultrasound, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, 215300, People's Republic of China.
² Department of Medical Ultrasound, Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, 213000, People's Republic of China.

Abstract

Background: The advantages of the dissecting the metastatic lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) remain a great deal of controversies in papillary thyroid carcinoma (PTC) patients without clinical evidence. The purpose of our retrospective research was to investigate the predictive factors of the LN-prRLN in cN0 PTC patients.

Methods and materials: Altogether 251 consecutive cN0 PTC participants accepted unilateral or bilateral thyroidectomy accompanied with LN-prRLN dissection between June 2020 and May 2023 were included in the research. Then, univariate and multivariate logical regression analysis were conducted to analyze the relationship between the LN-prRLN and these predictive factors, and a predictive model was also developed. Surgical complications of LN-prRLN dissection were also presented.

Results: The rate of LN-prRLN was 17.9% (45/251) in cN0 PTC patients after the analysis of postoperative histology. The age <55 years, multifocality, microcalcification, and BRAF^V600E mutation were identified to be predictive factors of LN-prRLN in cN0 PTC patients. The risk score for LN-prRLN was calculated: risk score = 1.192 × (if age <55 years) + 0.808 × (if multifocality) + 1.196 × (if microcalcification in nodule) + 0.918 × (if BRAF^V600E mutation in nodule). The rates of the transient hypoparathyroidism and hoarseness were 1.2% (3/251) and 2.0% (5/251), respectively.

Conclusion: The age <55 years, multifocality, microcalcification, and BRAF^V600E mutation are independent predictors of the LN-prRLN in cN0 PTC patients. An effective predictive model was established for predicting the LN-prRLN in cN0 PTC patients, with the aim to better guide the surgical treatment of PTC. A thorough inspection of the lateral compartment is recommended in PTC patients with risk factors. The multicenter research with long-term follow-up should be carried out to ascertain the optimal surgical approach for patients with PTC.

Keywords: BRAFV600E mutation; lymph nodes posterior to the right recurrent laryngeal nerve; papillary thyroid carcinoma; predictive model; ultrasound.

Grants and funding

We greatly acknowledged the social development science and technology plan project of Kunshan City (KSF2021131), and the clinical medical science and technology development fund project of Jiangsu University (JLY2021067).