Preoperative risk factors and recommendations for surgical intervention in cN0 papillary thyroid microcarcinoma

Abstract

The evaluation and management of papillary thyroid microcarcinoma (PTMC) have always been challenging and controversial. Our retrospective study aimed to investigate metastatic trend and risk factors of cN0 papillary thyroid microcarcinoma patients and provide advice for surgical strategies.The clinicopathologic features of 556 cN0 PTMC patients undergoing thyroidectomy combined identified by binary logistic regression analysis. Numbers of dissected lymph nodes (DLN) and metastatic lymph nodes (MLN) were analyzed using the Mann-Whitney U test to compare metastatic trends between different lobes. Male gender, tumor maximum diameter (TMD) larger than 5 mm, multifocality, and capsular/extracapsular invas ion were metastatic risk factors of central compartment metastasis (CCM) (p < 0.05). The number of DLN in the right level VI was larger than in the left (p < 0.05), while the number of MLN was similar (p > 0.05). The chance of CCM was higher when the number of DLN was larger than 5 (p < 0.05). After identified metastatic trends and risk factors, we recommend surgery for patients deciding on aggressive treatment, especially for cases where a combination of risk factors is present. And to ensure no residual metastatic lymph nodes and reduce secondary surgery rates, adequate lymphadenectomy on the diseased side would be a better choice considering the standard of care.

Clinicopathologic predictors of central lymph node metastases in clinical node-negative papillary thyroid microcarcinoma: a systematic review and meta-analysis

“…The 2015 American Thyroid Association guidelines strongly recommended that thyroidectomy without prophylactic CLND is appropriate for noninvasive CN0 PTMC [ 5 ]. Nevertheless, the previous studies revealed that the proportion of central lymph node metastases (CLNM) of CN0 unilateral PTMC was even higher than 40% [ 9 – 12 ]. In previous studies, the presence of CLNM was a significant factor related to recurrence-free survival in PTMC [ 13 ].…”

Prevalence of Central Compartment Lymph Node Metastases in Papillary Thyroid Micro-Carcinoma: A Retrospective Evaluation of Predictive Preoperative Features

“…According to some work, adequate lymphadenectomy could be a better choice to ensure no residual metastatic lymph nodes and reduce secondary surgery rates [ 24 ].…”

“…Our multivariate analysis identifies significant factors independent of each other to predict CLNM. Their significance in combination with different analyses may be the subject of future studies to achieve the conclusion of Liu C et al (2021): “the dissection should be performed especially for cases where a combination of risk factors is present” [ 24 ].…”

“…At the time of surgery, central lymph node metastases (CLNM) were observed in 20% to 90% of PTMC patients in different studies, despite negative preoperative imaging evaluation [ 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. While the clinical significance of PTMC lymph node metastases remains a matter of discussion, recent studies have reported CLNM as a potential marker of aggressive behavior of PTMC and a risk factor for recurrence, distant metastases, reduced survival, and higher morbidity [ 20 , 21 , 22 , 23 , 24 ].…”

“…To date, there is no consensus on the appropriate therapy strategy for PTMC patients. In the literature, the recommendation varies from an observational approach alone, to ultrasound-guided minimally invasive treatments, to conservative surgical treatment, and even to radical thyroidectomy with or without prophylactic central neck dissection [ 10 , 12 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. Almost all clinicians agreed CLND should be performed in the case of preoperative evidence of CLNM.…”