1. Cheng-Chiao Huang, MD, MSc
Risk Factors of Central Lymph Node Metastases in Papillary Thyroid Cancer
Cheng-Chiao Huang, MD, MSc
Division of Breast & Endocrine Surgery, TMUH
The Ph.D. Program for Cancer Biology and Drug Discovery, TMU

2. Thyroid Image Reporting And Data System
TIRADS 1 Normal thyroid gland
TIRADS 2 Benign conditions % malignancy
TIRADS 3 Probably benign nodules % malignancy
TIRADS 4 Suspicious nodules –80% malignancy
TIRADS 5 Probably malignant nodules >80% malignancy
TIRADS 6 Biopsy proven malignant nodules
A subdivision into 4a (malignancy between 5 and 10%) and 4b (malignancy between 10 and 80%) was optional
沒有TIRADS 0

3. TIRADS 3
TIRADS 4
TIRADS 5
RFA
Core biopsy

4. Current status of core needle biopsy of the thyroid
CNB has been suggested as an alternative to FNA in patients with previous nondiagnostic results or atypia of undetermined significance
It is also useful for the differentiation
rapidly growing thyroid tumors (lymphoma vs. anaplastic thyroid carcinoma)
follicular lesions (follicular neoplasm vs. nodular hyperplasia)
medullary thyroid carcinoma
calcified thyroid nodules
degenerating thyroid nodules
CNB要小心！

5. 40-year-old man Right thyroid nodule TIRADS 5 FNA
solid or almost completely solid: 2
hypoechoic: 2
wider than tall: 0
lobulated/irregular: 2
macrocalcifications: 1
TIRADS 5
FNA
atypical cellular change
CNB
papillary carcinoma

6. Total thyroidectomy? Known distant metastases
Tumor > 4cm in diameter
Cervical lymph node metastases
Poorly differentiated
Consider for prior radiation exposure (category 2B)
Consider bilateral nodularity
NCCN guidelines

8. 40-year-old man Right hemithyroidectomy Prophylactic CLND
Level VI lymph nodes
Negative (0/6)
pT1bN0M0 Stage I

9. Papillary thyroid cancer
February 2015 to August 2017
136 patients
Central neck lymph node dissection (CLND)
21.3%
78.7%

10. 13/29 (44.8%)
42/107 (39.3%)

11. Discussion
In thyroid cancer, women encounter a potentially higher incidence of the disease. However, several studies suggested that LNM rate in men was higher than that in women, and could be used as an independent predictor of LNM
The CLNM rate in <20 years group was as high as 90.9%. Thus, we proposed that the treatment of such patients with routine prophylactic CLND be rather beneficial
Liu et al. Medicine (2017) 96:43

12. Prophylactic CLND
Disease recurrence significantly lower (2.52% vs. 4.59%)
Transient RLN injury significantly higher (3.53% vs. 1.99%)
Transient hypocalcemia significantly higher (25.75% vs %)
Permanent hypocalcemia significantly higher (4.11% vs. 1.95%)
No significant difference in permanent RLN injury
No significant difference in disease-free survival
Chen L, et al. World J Surg. 2018

13. Take home messages
Thyroid core biopsy can prevent repeated FNA or unnecessary thyroidectomy
Tumor size > 2cm and extrathyroidal distension should consider prophylactic CLND
CLND helps us decide to perform total thyroidectomy or not, but must be careful