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

Abstract

Papillary thyroid micro-carcinomas are considered relatively indolent carcinomas, often occult and incidental, with good prognosis and favorable outcomes. Despite these findings, central lymph node metastases are common, and are related to a poor prognosis for the patient. We performed a retrospective analysis on patients treated with surgery for stage pT1a papillary thyroid micro-carcinomas. One hundred ninety-five patients were included in the analyses. The presence of central lymph node metastases was identified and studied. A multivariate analysis employing binary logistic regression was used to calculate adjusted odds ratios with 95% confidence intervals of possible central lymph node metastases risk factors. In the performed multivariate analysis, male gender, younger age, and histopathological characteristics, such as a tumor sub-capsular localization, were significantly associated with central lymph node metastases in pT1a patients. Central compartment lymph node metastases are present in a non-negligible number of cases in patients with papillary thyroid micro-carcinoma undergoing surgical resection. Studying these factors could be an effective tool for predicting patients’ central lymph node metastases in papillary thyroid micro-carcinomas, defining a tailored surgical treatment in the future.

Carbon nanoparticles beneficial for prophylactic central compartment lymph node dissection in cN0 papillary thyroid carcinoma

“…In this series of patients, only temporary hypoparathyroidism and vocal cord paralysis were documented, without any permanent occurrence, which could be attributed to the fact that experienced senior surgeons performed all the procedures. Moreover, pCCLND could be considered for patients with cN0 PTC, especially with the help of CNP, as this procedure could be considered relatively safe [ 15 ], and more than a quarter of lymph nodes harvested from the central compartment were metastatic. In fact, central compartment lymph node metastases (CCLNM) are common (20 %–90 %) and are related to a poor prognosis (including recurrence, distant metastases, reduced survival, and higher morbidity), even for patients with cN0 micro-PTC, despite negative preoperative imaging evaluation [ 15 ].…”

“…Moreover, pCCLND could be considered for patients with cN0 PTC, especially with the help of CNP, as this procedure could be considered relatively safe [ 15 ], and more than a quarter of lymph nodes harvested from the central compartment were metastatic. In fact, central compartment lymph node metastases (CCLNM) are common (20 %–90 %) and are related to a poor prognosis (including recurrence, distant metastases, reduced survival, and higher morbidity), even for patients with cN0 micro-PTC, despite negative preoperative imaging evaluation [ 15 ]. Unfortunately, the sensitivity of both ultrasound and CT imaging for CCLNM is reported to be 42–47 % [ 16 ]; therefore, more than half of patients might only present cN0, but they are not.…”

“…A more thorough dissection of the central compartment could lead to RAI treatment for more patients in need, which would otherwise not be administered for not meeting ATA intermediate risk criteria (>5 pathologic N1) [ 11 ], and this could potentially result in a better prognosis of such patients. So far, male sex, low age, sub-capsular carcinoma localization, multifocality, and ETE have been reported as independent predictive factors for CCLNM in pT1a PTC [ 15 , 17 ]. Hence, pCCLND should be considered at least for patients with cN0 PTC.…”

Role of prophylactic central neck lymph node dissection for papillary thyroid carcinoma in the era of de-escalation

“…For stage pT1α papillary thyroid microcarcinoma, multivariate analyses have demonstrated that younger age, male sex, and subcapsular location of the lesion were predictive factors for central lymph node metastasis[ 82 ].…”

A clinical and molecular pathology prediction model for central lymph node metastasis in cN0 papillary thyroid microcarcinoma

“…Papillary thyroid carcinoma itself has relatively indolent biological characteristics and superadd the small tumor burden; PTMC patients usually have a good prognosis after treatment ( 4 ). The 2022 National Comprehensive Cancer Network (NCCN) advises against utilizing prophylactic CLND to treat T1 and T2 cN0 PTC ( 5 ).…”