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Characteristics and risk factors of cervical lymph node metastasis in cN0 papillary thyroid microcarcinoma of the isthmus

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Abstract

The surgical resection range of papillary thyroid microcarcinoma of the isthmus (PTMCI) is controversial, and the guidelines do not fully guide the central lymph node dissection (CLND).We retrospectively studied the comparison of PTMCI (Group A, n = 65 cases) and non-PTMCI (Group B, n = 80 cases). Based on whether central lymph node metastasis (CLNM) was further detected, they were further divided into the PTMCI with CLNM (group C, n = 42 cases), the PTMCI without CLNM (group D, n = 23 cases), the non-PTMCI with CLNM (group E, n = 45 cases), the non-PTMCI without CLNM (group F, n = 35 cases). All patients underwent total thyroidectomy and CLND. The CLNM pathological examination was divided into right recurrent laryngeal nerve superficial lymph nodes (Right VI a), right recurrent laryngeal nerve deep lymph nodes (Right VI b), left VI area lymph nodes (Left VI), prelaryngeal lymph node, and pretracheal lymph node. The extent of lymph node metastasis and risk factors of PTMCI were analyzed by univariate and multivariate analysis. The ROC curve was used to calculate the maximum diameter of the tumor and the Youden index was calculated to analyze the impact of diameter on the risk factors for CLNM in PTMCI. To construct a prediction model of transfer risk of high risk factors by Nomogram, there were significant differences in prelaryngeal lymph nodes (p = 0.034) and pretracheal lymph nodes ( n = 0.035) between group A and group B, and the risk factors of lymph node metastasis were tumor invasion (p = 0.003), multifocality (p = 0.001), and the maximum tumor diameter≧6.5 mm. PTMCI is more prone to metastasis of pretracheal lymph nodes and prelaryngeal lymph nodes, and the presence of tumor invasion, multifocality, and tumor diameter≧6.5 mm are high risk factors for metastasis in PTMCI. According to the prediction model, with all risk factors the risk of cervical lymph node metastasis is up to 90%.

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Data availability

All data are available for further use.

Abbreviations

PTMCI:

Papillary thyroid microcarcinoma of the isthmus

PTMC:

Papillary thyroid microcarcinoma

CLNM:

Cervical lymph node metastasis

CLND:

Central lymph node dissection

Right VI a:

Right recurrent laryngeal nerve superficial lymph nodes

Right VI b:

Right recurrent laryngeal nerve deep lymph nodes

Left VI:

Left VI area lymph nodes

TSH:

Thyroid stimulating hormone

TG:

Thyroglobulin

TGAb:

Anti-thyroglobulin antibody

ROC:

Receiver operating characteristic curve

FNAB:

Fine needle aspiration biopsy

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Acknowledgements

The work was supported by Sichuan Provincial Cancer Hospital, all colleagues in department head and neck surgery, and Linjie Ma is the corresponding author, provide financial support.

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  1. Department of Head and Neck Surgery, Sichuan Cancer Hospital, Sichuan Cancer Institute, Sichuan Cancer Prevention and Treatment Center, Cancer Hospital of University of Electronic Science and Technology School of Medicine, No. 55 Section4, Renming South Road, Chengdu, China

    Linjie Ma

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Linjie Ma, M.D. master: The first author, mainly responsible for data analysis and manuscript writing.

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Correspondence to Linjie Ma.

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The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013).

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This research involved only human participants and no animals, and was performed in accordance with the 1964 Helsinki Declaration. This study was approved by the institutional Ethics Committee of Sichuan Provincial Cancer Hospital.

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Ma, L. Characteristics and risk factors of cervical lymph node metastasis in cN0 papillary thyroid microcarcinoma of the isthmus. Updates Surg (2024). https://doi.org/10.1007/s13304-024-01760-3

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