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Clinical Features in Differentiated Thyroid Carcinoma Stratified By Lymph Node Status.

Jawairia Shakil1, Trisha D Cubb2, Ahmad Yehya2

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Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
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Cervical lymph node metastases in differentiated thyroid cancer are linked to larger, multicentric tumors. Increased vigilance is advised for tumors over 2 cm and those with elevated thyroglobulin auto-antibodies.

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Area of Science:

  • Oncology
  • Endocrinology
  • Surgical Pathology

Background:

  • Cervical lymph node (CLN) metastases are common in differentiated thyroid cancer (DTC) and predict local recurrence.
  • Lymph node status is a critical factor in DTC staging and management.
  • Understanding the clinical implications of lymph node involvement is essential for patient outcomes.

Purpose of the Study:

  • To evaluate clinical endpoints in differentiated thyroid cancer (DTC) patients based on cervical lymph node (CLN) metastasis status (N1, N0, Nx).
  • To correlate lymph node involvement with key clinical and pathological features of DTC.
  • To identify predictors of CLN metastasis in DTC.

Main Methods:

  • Retrospective review of 261 DTC patients who underwent thyroidectomy (2006-2018).
  • Classification of lymph node status according to AJCC 8th edition criteria (N1, N0, Nx).
  • Statistical analysis including one-way ANOVA and pairwise comparisons to assess group differences.

Main Results:

  • Significant differences observed in tumor multicentricity, tumor size, AJCC stage, and thyroglobulin auto-antibody (TgAb) levels among N1, N0, and Nx groups.
  • N1 patients exhibited higher rates of multicentricity, larger tumors, and elevated TgAbs.
  • No significant differences were found between the N0 (negative lymph nodes) and Nx (unresected lymph nodes) groups.

Conclusions:

  • Larger and multicentric tumors are associated with a higher likelihood of CLN metastases in DTC.
  • Elevated TgAbs may indicate a higher risk of CLN involvement.
  • Recommendations include increased surveillance for CLN metastases in DTC patients with tumors >2 cm, multicentric tumors, or elevated TgAbs.