PAPILLARY THYROID CARCINOMA SIZE;

ASSOCIATION WITH LYMPH NODE METASTASIS

Abstract

Background: Papillary thyroid carcinoma (PTC) is the most common malignancy
of thyroid gland. It constitutes about 90% of all well differentiated thyroid carcinomas and has an
indolent course with excellent prognosis.1,2,3 Death due to papillary thyroid carcinoma is rare and
accounts for only 0.2% of cancer deaths in United States of America.4 The prevalence of PTC
has increased world over due to the wider use of ultrasonography and fine needle aspiration
cytology (FNAC) in the routine diagnostic workup. Also papillary thyroid microcarcinomas
(PTMC) are being increasingly diagnosed as incidental findings in thyroid gland removed for
other thyroid pathologies, like follicular adenoma, multi-nodular goiter or diffuse goiter, etc. Due
to uncertainty for this tumor to metastasize to the regional lymph nodes, it is usually not clear
whether the surgeon should take the patient to the operating room and proceed with lymph
node dissection or to wait and observe. Study Design: In this retrospective study from the year
Period: January 2012 to January 2015, a total of 43 cases of total thyroidectomy with regional
lymph node dissection and with histopathological diagnosis of papillary thyroid carcinoma
were retrieved from archives of Setting: Charsada Teaching Hospital affiliated with Jinnah
Medical College Peshawar. The slides and diagnoses of all the retrieved cases were reviewed.
Information regarding primary tumor size, any metastasis in regional lymph nodes, patient’s
age and presence or absence of any associated thyroid disease was noted and analyzed.
Results: The analysis of the 43 cases of PTC showed that papillary thyroid carcinoma was more
common in females than males. It affected age groups between 10 and 80 years of age and
was most common in the 4th decade of life. Cervical lymph node metastasis was directly related
with the size of primary papillary thyroid carcinoma. The commonly associated thyroid diseases
included Hashimoto’s thyroiditis, followed by multinodular goiter and rarely Graves’ disease.
Conclusions: Papillary thyroid carcinoma is more common in females; it affects patients in their
fourth decade of life and is commonly associated with Hashimoto’s thyroiditis. Moreover the
chances of cervical lymph node metastasis are directly proportional to the primary tumor size.