Papillary carcinoma of the thyroid I. Developing pattern of metastasis

Abstract

Seventy‐one cases of papillary adenocarcinoma of the thyroid were operated on from January 1967 to July 1968. in 14 cases, the diagnosis of carcinoma was established postoperatively, so that 57 patients underwent systematic lymph node excision. Among these 57 cases, 90% had evidence of metastasis. a majority of metastatic deposits were small, i.e., 57% of them were less than 3 mm in diameter. There was no relationship between the location of primary tumor and metastasis; the initial metastases were most commonly observed in the pre‐ and paratracheal nodes, and subsequently, metastases were noted in the deep inferior and lateral cervical nodes. in patients who had a small number of metastatic deposits, the metastases were concentrated in the following sequence: pre‐ and paratracheal nodes, deep lower and lateral, and deep upper submandibular nodes. in those who had extensive metastases, the sequence of concentration was as follows: pre‐ and paratracheal, paraglandular and deep upper cervical, deep lower and lateral, and submandibular. From these observations, it can be concluded that metastasis of papillary thyroid carcinoma occurs first in paratracheal nodes, regardless of the location of the primary tumor. in the early stages, metastases are more frequent in the lower part of the neck. in later stages, when lymphatic obstruction has occurred, metastases appear in upper and submandibular nodes. Copyright © 1970 American Cancer Society