Papillary Thyroid Carcinoma: Analysis of the Size of the Primary Tumor, Infiltration of the Thyroid Capsule and Lymfangioinvasiona Due to Metastatic Involvment of Regional Lymph Nodes and Age

Authors: M. Sičák 1;  J. Sojak 1,2;  M. Slašťan 3;  A. Kališ 4
Authors‘ workplace: Slovenská zdravotnícka univerzita v Bratislave, Katolícka univerzita v Ružomberku, Klinika otorinolaryngológie a chirurgie hlavy a krku, Ústredná vojenská nemocnica – Fakultná nemocnica v Ružomberku 1;  Univerzita Komenského v Bratislave, Jesseniova lekárska fakulta v Martine, Ústav patologickej fyziologie 2;  Univerzita Komenského v Bratislave, Jesseniova lekárska fakulta v Martine, Ústav lekárskej biochemie 3;  Katolícka univerzita v Ružomberku, Ústav patologickej anatómie, Ústredná vojenská nemocnica – Fakultná nemocnica v Ružomberku 4
Published in: Otorinolaryng. a Foniat. /Prague/, 62, 2016, No. 4, pp. 224-231.
Category: Original Papers


In patients with papillary carcinoma of thyroid gland TNM classification is used to asses clinical stage, with age of 45 years being one of the basic criteria. The aim of this study was to analyze the size of the primary tumor, capsule infiltration, invasion of regional lymphatic vessels, multifocal disability and metastatic involvement of regional lymph nodes of the neck with respect to the 45 year age limit.

In a retrospective study we did a statistical analysis of a group of 336 patients suffering from papillary thyroid carcinoma. The group was divided into 135 patients under 45 years of age and 201 patients over 45 years of age.

When comparing the group of patients of age under 45 years and over 45 years we have found the metastatic involvement of cervical lymph nodes (N1) to be 54,1 % vs. 26,9 % of patients respectively, P<0.001 (P=0.000072) and multifocal involvement in 31,9% vs. 25,9 % of patients respectively , P<0.05 (P=0.025). In the group under 45 years we have found the size of the tumor to be ≥1cm significantly more often in the N1 subgroup, P<0.01 (P=0.0015). In patients older than 45 years there was no difference in size of tumor comparing N1 and N0 subgroups. In the group of patients under 45 years of age was statistically higher frequency of lymphangioinvasion in N1 subgroup, P<0.01 (P=0.0063). More frequent infiltration of the capsule of thyroid gland in the N1 subgroup was in both age groups, under 45 years P<0.001 (P=0.0000001) as well as in the group of over 45 years P<0.001 (P=0.0008).

In the group of patients with papillary thyroid carcinoma under 45 years of age, compared to the group of patients over 45 years of age, we have noted significantly higher incidence of metastatic involvement of regional lymph nodes and multifocal involvement. In younger patients with N1 we noted higher lymphangioinvasion and tumor size over 10 mm.

papilary thyroid carcinoma, age , regional lymph nodes involvement, risk factors


1. Astl, J., Čelakovský, P.: Nádory štítné žlázy. In Čelakovský, P., Plzák, J., Betka J. a kol.: Krční metastázy. Tobiáš, 2012, s. 232-238.

2. Betka, J., Mrzena, L., Astl, J. et al.: Surgical treatment strategy for thyroid gland carcinoma nodal metastases. Eur. Arch. Otorhinolaryngol., 254 (Suppl. 1), 1997, s. 169-174. 3. Bilimoria, K. Y., Bentrem, D. J., Ko, C. Y. et al.: Extent of surgery affects survival for papillary thyroid cancer. Ann. Surg., 246, 2007, s. 375-381.

4. Brierley, J. D., Panzarella, T., Tsang, R. W. et al.: A comparison of different staging systems predictability of patient outcome. Thyroid carcinoma as an example. Cancer, 79, 1997, s. 2414-2423.

5. Carling, T., Carty, S. E., Ciarleglio, M. M. et al.: American thyroid association design and feasibility of a prospective randomized controlled trial of prophylactic central lymph node dissection for papillary thyroid carcinoma. Thyroid, 22, 2012, s. 237-244.

6. Cooper, D. S., Doherty, G. M., Haugen, B. R. et al.: Revised american thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 19, 2009, s. 1167-1199.

7. Čelakovský, P., Plzák, J., Kalfeřt, D. et al.: Krční disekce u papilárního karcinomu štítné žlázy. Otorinolaryng. a Foniat. /Prague/, 64, 2015, 2, s. 93-97.

8. Ďurík, S., Sičák, M., Obtulovič, M. et al.: Identifikácia a monitoring návratného nervu pri revíznych operáciách štítnej žľazy. Otorinolaryng. a Foniat. /Prague/, 58, 2009; 3, s. 166.

9. Esnaola, N. F., Cantor, S. B., Sherman, S. I. et al.: Optimal treatment strategy in patients with papillary thyroid cancer: a decision analysis. Surgery, 130, 2001, s. 921-930.

10. Grimm, O., Rath, F. W., Dralle, H.: Pattern of lymph node metastases in papillary thyroid carcinoma. Brit. J. Surg., 85, 1998, s. 252-254.

11. Hartl, D. M., Mamelle, E., Borget, I. et al.: Influence of prophylactic neck dissection on rate of retreatment for papillary thyroid carcinoma. World J. Surg., 37, 2013, s. 1951-1958.

12. Hay, I. D., Grant, C. S., Bergstralh, E. J. et al.: Unilateral total lobectomy: is it sufficient surgical treatment for patients with AMES low-risk papillary thyroid carcinoma? Surgery, 124, 1998, s. 958-964.

13. Hay, I. D., Thompson, G. B., Grant, C. S. et al.: Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940–1999): temporal trends in initial therapy and long-term outcome in 2444 consecutively treated patients. World J. Surg., 26, 2002, s. 879-885.

14. Chow, S. M., Law S. C., Chan, J. K. et al.: Papillary microcarcinoma of the thyroid-Prognostic significance of lymph node metastasis and multifocality. Cancer, 98, 2003, s. 31-40.

15. Ito, Y., Uruno, T., Nakano, K. et al.: An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid, 13, 2003, s. 381-387.

16. Lebolleux, S., Rubino, C., Baudin, E. et al.: Prognostic factors for persistent or recurrent disease of papillary thyroid carcinoma with neck lymph node metastases and or tumor extension beyond the thyroid capsule at initial diagnosis. J. Clin. Endocrinol. Metab., 90, 2005, s. 5723-5729.

17. Links, T. P., van Tol, K. M., Jager, P. L. et al.: Life expectancy in differentiated thyroid cancer: a novel approach to survival analysis. Endocr. Relat. Cancer, 12, 2005, s. 273-280.

18. Mazzaferri, E. L.: An overview of the management of papillary and follicular thyroid carcinoma. Thyroid, 9, 1999, s. 421-427.

19. Pacini, F., Schlumberger, M., Dralle H. et al.: European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur. J. Endocrinol., 154, 2006, s. 787-803.

20. Patron, V., Hitier, M., Bedfert, C. et al.: Predictive factors for lateral occult lymph node metastasis in papillary thyroid carcinoma. Eur. Arch. Otorhinolaryngol., 270, 2013; s. 2095-2100.

21. Pitoia, F., Ward, L., Wohllk, N. et al.: Recommendations of the Latin American Thyroid Society on diagnosis and management of differentiated thyroid cancer. Arq. Bras. Endocrinol. Metabol., 53, 2009, s. 884-887.

22. Qubain, S. W., Nakano, S., Baba, M. et al.: Distribution of lymph node micrometastasis in pN0 well-differentiated thyroid carcinoma. Surgery, 131, 2002, s. 249-256.

23. Sojak, J., Sičák, M., Obtulovičová, K. et al.: Papilárny karcinóm štítnej žľazy: perioperačný manažment chirurgickej liečby. Interná med., 13, 2013; s. 451-455.

24. Takami, H., Ito, Y., Okamoto, T. et al.: Therapeutic strategy for differentiated thyroid carcinoma in Japan based on a newly established guideline managed by Japanese Society of Thyroid Surgeons and Japanese Association of Endocrine Surgeons. World J. Surg., 35, 2011, s. 111-121.

25. Teixeira, G., Teixeira, T., Gubert, F. et al.: The incidence of central neck micrometastasis disease in patients with papillary thyroid cancer staged preoperatively and intraoperatively as N0. Surgery, 150, 2011, s. 1161-1167.

26. Zaydfudim, V., Feurer, I. D., Griffin, M. R. et al.: The impact of lymph node involvement on survival in patients with papillary and folicular thyroid carcinoma. Surgery, 144, 2008, s. 1070-1078.

Audiology Paediatric ENT ENT (Otorhinolaryngology)
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account