Background: Therapeutic lateral neck dissection (LND) is recommended in papillary thyroid carcinoma (PTC) patients with clinically lateral lymph node metastasis (LLNM), whether underwent level V LND remains controversial for lacking of sensitive predicting system. BRAF V600E mutation is associated with aggressive tumor behavior, recurrence, and disease-specific mortality of PTC. However, the relationship between BRAF V600E mutation and level V LNM is unclear. Methods: Univariate and multivariate analyses were retrospectively conducted on the potential predictive factors of 252 PTC patients who underwent initial treatment of neck lymph node dissection from September 2015 to October 2018 in our institute. BRAF V600E mutation and the clinicopathological characteristics of the two groups were compared. Results: LLNM was presented in 208 (82.5%) patients and level II-V LNM was present in 42.8%, 71.2%, 85.1%, 17.8% patients, respectively. BRAF V600E mutation was observed in 188 (74.6%) patients and was significantly associated with patients' age, lymphocytic thyroiditis, capsule invasion, bilateral central lymph node metastasis (CLNM) and level V LNM in PTC. Univariate analysis revealed that lymphocytic thyroiditis, tumor size, number of CLNM, Level II LNM, Level III LNM, simultaneous Level II+III, simultaneous Level III+IV and simultaneous Level II+III+IV were significantly correlated with Level V LNM. In addition, multivariate analysis revealed that tumor size ≥2.5 cm, number of CLNM≥3, level II metastases and BRAF V600E mutation were independent Level V LNM predictors (odds ratio 3.910, 3.660, 8.410, 0.439; 95% CI 1.737-10.135, 1.054-12.713, 1.233-57.355, 0.280-0.827, respectively). Conclusion: In summary, we presented several independent predictive factors for level V LNM in PTC patients. We constructed a risk prediction model consisting of tumor size ≥2.5 cm, number of CLNM≥3 and level II metastases and BRAF V600E mutation that may guide surgeons to evaluate the nodal status in PTC and perform tailored therapeutic LND.

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Background: Cervical lymph node metastasis (LNM) is an independent risk factor for poor prognosis of papillary thyroid carcinoma (PTC), but the scope of PTC lateral neck dissection (LND) is controversial. Solitary lateral lymph node metastasis (SLNM) is a special type of PTC with lateral LNM. Currently, study on the preoperative clinical characteristics of SLNM has been seldomly reported. This study evaluated the preoperative characteristics for predicting the SLNM of PTC. Methods: We included 391 patients diagnosed with PTC between May 2011 and July 2017. Among those patients, 44 had SLNM and 347 had multiple lateral neck node metastasis (MLNM). The clinicopathologic characteristics and other central lymph node metastasis risk factors were retrospectively analyzed. Results: Univariate analysis revealed that age and tumor size (≤1 cm) were significantly correlated with SLNM. In ROC curve analysis, the optimal cutoff age of preoperative predictors for the prediction of SLNM was 46.5 years (AUC=0.623, 0.536-0.710). Besides, the frequency and mean number of CLNM was significantly less in the SLNM than MLNM group. The oval and round tumor shape and well-defined margin of the tumor were more common in the SLNM group (p =0.001; p=0.024, respectively). In addition, multivariate analysis revealed that age ≥47, capsular invasion, no extrathyroidal extension, with central lymph node metastases and irregular shape were independent SLNM predictors of PTCs (odds ratio 2.386, 0.173, 0.284, 0.239, 0.188; 95%

Purpose Residues from the LN-prRLN are one of the main reasons for persistence or recurrence in patients with papillary thyroid carcinoma (PTC). However, the methods for preoperative assessment of LN-prRLN status, as well as the correlation with other clinicopathological features remains unclear. Methods Clinicopathological feature of 493 patients with PTC were retrospectively reviewed. Univariate and multivariate analyses were performed to identify the independent risk factors of LN-prRLN metastasis. The implications of positive LN-prRLN on right lateral lymph node and contralateral central lymph node metastasis were also investigated. Results Among the 493 patients, 343 (69.6%) was women and the average age was 39.06 ± 10.63 years old. Male sex, tumor size > 10 mm, extrathyroidal extension, the number of lymph nodes anterior to the right recurrent laryngeal nerve (LN-arRLN) metastasis ≥ 1, and right lateral lymph node metastasis (right-LLNM) were found as the independent risk factors of LN-prRLN metastasis in PTC. The prediction model based on those five factors performed better than the other forecast models. Moreover, positive LN-prRLN, male sex, microcalcifications, and tumor size > 10 mm significantly increases the risk of right-LLNM. Meanwhile, positive LN-prRLNand male sex will significantly increase the risk of con-CLNM. Conclusions LN-prRLN dissection should be recommended in patients with male sex, tumor size > 10 mm, extrathyroidal extension, the number of LN-arRLN metastasis ≥ 1, and present right-LLNM. Furthermore, when LN-arRLN metastasis has occurred, surgeons should be more alert to the possibility of right lateral lymph node and contralateral central lymph node metastasis.