High-risk factors for ipsilateral lateral neck lymph node metastasis in clinically node-negative patients with papillary thyroid microcarcinoma (cT1aN0)

Abstract

Background: The incidence of papillary thyroid microcarcinoma (PTMC) increases yearly. There are several studies on the high-risk factors for lymph node metastasis in the central compartment of PTMC but few studies on the high-risk factors for lateral neck lymph node (LNLN) metastasis. Few studies have analyzed the high-risk factors for LNLN metastasis for clinically lymph node-negative PTMC patients in stage T1a (cT1aN0). We investigated the risk factors for LNLN metastasis in these patients. Methods: In total, 127 PTMC (cT1aN0) patients underwent hemi-or total thyroidectomy with ipsilateral central lymph node dissection (CLND) plus lateral lymph node dissection (LLND), including levels III and IV, between 2018 and 2019 in our hospital. Univariate and multivariate analyses identified the high-risk factors for LNLN metastasis in PTMC (cT1aN0). Results: The rate of LNLN metastasis was 21.26% (27/127). The multivariate analysis showed that capsular invasion (p=0.027), tumor location at the superior pole (p=0.002) and ipsilateral central lymph node positivity (p=0.001) were independent risk factors for LNLN metastasis in PTMC patients (cT1aN0), with odds ratios (ORs) of 0.181 (95% confidence interval (95% CI): 0.039-0.827), 5.994 (95% CI: 1.949-18.435) and 6.182 (95% CI: 2.193-17.425), respectively. Conclusions: These findings indicate that capsular invasion, tumor location at the superior pole and ipsilateral central lymph node positivity are independent high-risk factors for LNLN metastasis in clinically node-negative PTMC (cT1aN0) patients. High-risk factors should be correctly evaluated to guide surgical treatment for PTMC patients.

Association between papillary thyroid carcinoma and cervical lymph node metastasis based on ultrasonic radio frequency signals

“…Linear regression analysis showed the greatest correlation between tumor maximum diameter and CLNM, which was consistent with the results of previous studies. 26,27 T A B L E 2 Univariate analysis of the quantitative RF signal parameters with CLNM in PTC. Aspect ratio ≥1 was a highly specific indicator for the diagnosis of malignant thyroid nodules.…”

“…Aspect ratio ≥1 was a highly specific indicator for the diagnosis of malignant thyroid nodules. 28,29 Studies 26,30 show that aspect ratio >1 is associated with a higher likelihood of CLNM. In this study, cross-sectional and longitudinal aspect ratio according to tumor morphology were statistically significant in the univariate analysis (p < 0.05); however, the AUC values were <0.50 for both, which may be related to the low number of cases enrolled.…”