Martha J Griffin1, Fred M Baik2, Margaret Brandwein-Weber3, Muhammad Qazi4, Lauren E Yue5, Marcela Osorio5, Mark L Urken5,6. 1. THANC (Thyroid, Head and Neck Cancer) Foundation, 10 Union Square East, New York, NY, 10003, USA. mgriffin@thancfoundation.org. 2. Department of Otolaryngology - Head and Neck Surgery, Stanford University Medical Center, Stanford, CA, USA. 3. Department of Pathology, Mount Sinai West, Mount Sinai Health System, New York, NY, USA. 4. Department of Pathology, University of Wisconsin School of Medicine, Madison, WI, USA. 5. THANC (Thyroid, Head and Neck Cancer) Foundation, 10 Union Square East, New York, NY, 10003, USA. 6. Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Beth Israel, New York, NY, USA.
Abstract
BACKGROUND: Current American Thyroid Association (ATA) guidelines state that patients with intermediate-risk papillary thyroid cancer (PTC) may benefit from remnant ablation. One criterion for intermediate-risk classification is >5 positive lymph nodes (LNs). We investigate whether performing step-sectioning of LNs increases the metastatic detection rate, thereby influencing ATA risk of recurrence (ROR) classification. METHODS: A retrospective review was conducted of cases in which ≥ 5 LNs were removed during thyroidectomy and ≤5 LNs were found positive for PTC. Step-sectioning was performed on the original tissue blocks. All slides were re-reviewed by a senior pathologist. RESULTS: Twenty patients met study criteria. Step-sectioning significantly increased LN yield compared to standard sectioning. In total, we found 12 new positive lymph nodes; seven (58%) were in totally new lymph nodes, while five (42%) were in lymph nodes previously read as negative. All newly discovered metastases were classified as micrometastases (≤2 mm). Of the 15 patients originally classified as low-risk, the step-sectioning protocol impacted two patients (13%), increasing ROR stratification. CONCLUSION: Intensive step-sectioning reveals additional micrometastases. More detailed analysis did not identify clinically significant nodal disease likely to impact the clinical course of patients in this study. Our study supports current standards of pathology specimen handling related to LN assessment and the impact on ATA ROR classification. Nonetheless, it is important for clinicians to understand their institution's sectioning protocol utilized to report positive and total LN counts, which could impact ATA risk stratification and denote the comprehensive nature of the LN dissection that was performed.
BACKGROUND: Current American Thyroid Association (ATA) guidelines state that patients with intermediate-risk papillary thyroid cancer (PTC) may benefit from remnant ablation. One criterion for intermediate-risk classification is >5 positive lymph nodes (LNs). We investigate whether performing step-sectioning of LNs increases the metastatic detection rate, thereby influencing ATA risk of recurrence (ROR) classification. METHODS: A retrospective review was conducted of cases in which ≥ 5 LNs were removed during thyroidectomy and ≤5 LNs were found positive for PTC. Step-sectioning was performed on the original tissue blocks. All slides were re-reviewed by a senior pathologist. RESULTS: Twenty patients met study criteria. Step-sectioning significantly increased LN yield compared to standard sectioning. In total, we found 12 new positive lymph nodes; seven (58%) were in totally new lymph nodes, while five (42%) were in lymph nodes previously read as negative. All newly discovered metastases were classified as micrometastases (≤2 mm). Of the 15 patients originally classified as low-risk, the step-sectioning protocol impacted two patients (13%), increasing ROR stratification. CONCLUSION: Intensive step-sectioning reveals additional micrometastases. More detailed analysis did not identify clinically significant nodal disease likely to impact the clinical course of patients in this study. Our study supports current standards of pathology specimen handling related to LN assessment and the impact on ATA ROR classification. Nonetheless, it is important for clinicians to understand their institution's sectioning protocol utilized to report positive and total LN counts, which could impact ATA risk stratification and denote the comprehensive nature of the LN dissection that was performed.
Authors: C Dobrinja; M Troian; T Cipolat Mis; G Rebez; S Bernardi; B Fabris; L Piscopello; P Makovac; F Di Gregorio; N de Manzini Journal: Int J Surg Date: 2017-05 Impact factor: 6.071
Authors: Rikke Riber-Hansen; Nina Hastrup; Ole Clemmensen; Nille Behrendt; Siri Klausen; Mette Ramsing; Eva Spaun; Stephen Jacques Hamilton-Dutoit; Torben Steiniche Journal: Eur J Cancer Date: 2011-10-22 Impact factor: 9.162
Authors: Gregory W Randolph; Quan-Yang Duh; Keith S Heller; Virginia A LiVolsi; Susan J Mandel; David L Steward; Ralph P Tufano; R Michael Tuttle Journal: Thyroid Date: 2012-10-19 Impact factor: 6.568
Authors: Young Ran Hong; So Hee Lee; Dong Jun Lim; Min Hee Kim; Chan Kwon Jung; Byung Joo Chae; Byung Joo Song; Ja Seong Bae Journal: World J Surg Oncol Date: 2017-04-04 Impact factor: 2.754