Introduction: Although thyroid cancer is the most prevalent endocrine
malignancy, however it's responsible for less than 0.5% of cancer related death.
Large number of researches had examined different factors that may affect
recurrence such as age, sex, thyroid tumor size, histological types, and
lymphatic invasion, which had all been used as an indicator for poor outcome.
In our study, Lymph node (L.N.) capsular invasion by tumor had been assessed
as a factor affecting recurrence in well differentiated thyroid cancer patients
(WDTC) after first recurrence.
Aim: To assess the effect of neck L.N. capsular invasion in well differentiated
thyroid cancer on subsequent recurrences
Patients and methods: This retrospective cohort study was carried on 40
patients with neck recurrence of WDTC who were referred to National cancer
institute (NCI) between June 2014 and June 2015. Data was collected regarding
initial disease stage, type of recurrence, time till recurrence, investigation done,
and previous treatment. Adequate management of those patients was done
(further investigation and surgical treatment), histopathology are obtained and
documented
Results: Of the 40 patients included in the study, 35 patients showed nodal
affection in their first recurrence, with 15 of them showed
L.N. capsular invasion. Of these 15 patients, 7 patients showed subsequent
second recurrence (46.7%), 3 of them with nodal affection and 4 with operative
bed only recurrence. L.N capsular invasion was found in 3 patients of the 7 with
second recurrence. Of the 25 patients with no L.N. capsular invasion in their
first recurrence only 8 showed second recurrence (32%).
Conclusion: Among those patients with multiple recurrence of WDTC, males
that aged over 40 years with aggressive primary tumor and advanced stage, and
those with L.N. capsular invasion, have a significant risk of multiple recurrence
and possibly poor outcome. L.N. capsular invasion showed that it may be an
important factor for further recurrences which may put those patients among
higher risk group that need more aggressive management and more precise
follow up.