Central Neck Compartment Metastases in Tall-Cell Variant of Papillary Thyroid Cancer

Objective: Recent American Thyroid Association (ATA) guidelines suggest a role for prophylactic central neck dissection in patients with papillary thyroid cancer (PTC). No studies directly address this subject in patients with the tall-cell-variant (TCV) of PTC. We sought to determine the risk of metastasis to the central compartment in patients with TCV. Method: A retrospective review was performed of all cases of papillary thyroid cancer undergoing primary surgical therapy with central neck dissection (CND) at our institution from 2007-2010. Charts were reviewed for demographic data, and pathology was reviewed for tumor histology, size, multi-focality, CND positivity, and extra-thyroidal extension (ETE). Results: A total of 63 patients with PTC underwent primary surgical therapy with CND, 10 of whom had TCV. Five of the TCV patients had positive nodes (50%), whereas only 18 of the 53 classical PTC had positive nodes (34%). TCV tumors were significantly larger than PTC tumors (1.8 cm 1.2 cm, P < .005). In both groups, a larger tumor size correlated with a significantly higher incidence of positive CND ( P < .05 for TCV, and P < .01 for PTC). In the PTC group, ETE correlated with significantly higher incidence of positive CND ( P = .001). Patients’ age and tumor multi-focality did not correlate with increased positive CND in either group. Conclusion: Central compartment metastases occurred in 50% of TCV and 34% of classical PTC. This may be due to the fact that TCV tumors presented with a significantly larger size when metastases were already present. The findings of this study support the ATA recommendation for CND in patients with TCV.