Clinical and pathologic predictors of central lymph node metastasis in papillary thyroid microcarcinoma: a retrospective cohort study
To identify the clinical and pathological predictors of central lymph node metastasis (CLNM) in patients with clinically lymph node-negative papillary thyroid microcarcinoma (PTMC).
Materials and methods
Data pertaining to 541 clinically lymph node-negative PTMC patients who underwent thyroid surgery at the Shanghai General Hospital between January 2010 and December 2013 were retrospectively analyzed. According to histopathological evidence of central lymph node involvement, patients were divided into central lymph node metastasis (CLNM)-positive and CLNM-negative groups; risk factors for CLNM were identified statistically.
LNM was found in 148 (27.4%) patients. Gender (P = 0.002), age (P < 0.001), tumor size (P < 0.001), multifocality (P < 0.001), and extrathyroidal extension (P < 0.001) were significantly different between CLNM-positive and CLNM-negative groups. On multivariate analyses, male sex (odds ratio [OR] = 2.656), age <45 years (OR = 4.184), tumor size >0.575 cm (OR = 2.105), gross extrathyroidal extension (OR = 14.605) and multifocality (OR = 2.084) were independent risk factors for CLNM. Among patients who did not have any of these five risk factors, only 3.9% were found to have CLNM.
A relatively high prevalence of CLNM was observed in patients with clinically lymph node-negative PTMC. CLNM was associated with male sex, younger age, larger tumor size, extrathyroidal extension and multifocal PTMC.
KeywordsPapillary thyroid microcarcinoma Central lymph node metastasis Central lymph node dissection
All authors participated in various aspects of the study analysis and interpretation of the data, and in the development of the report. The final version was read and approved by all authors. Chunyi Gui and Min Wang conceived and designed the study and drafted the manuscript. Shenglong Qiu and Min Wang participated in data collection. Chunyi Gui and Zhihai Peng performed the statistical analysis.
Compliance with ethical standards
Conflict of interest
The authors have no conflicts of interest to declare.
This research was approved by the Institutional Review Board and Clinical Ethics Committee of Shanghai General Hospital, Shanghai Jiaotong University School of Medicine. The requirement for written informed consent of the patients or their representatives was waived off due to the retrospective nature of this study, in accordance with the guidelines of the American Medical Association. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
No informed consent needed.
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