Rethinking indications for prophylactic central neck dissection in papillary thyroid microcarcinoma: A real-world retrospective study.

BACKGROUND

The treatment of unifocal papillary thyroid microcarcinoma (PTMC) remains controversial. The study analyzed preoperative clinical characteristics and postoperative pathologic features of unifocal PTMC to provide new insights into whether prophylactic central neck dissection (pCND) should be performed in PTMC.

METHODS

A total of 1475 patients with clinical lymph node-negative (cN0) unifocal PTMC who underwent thyroid lobectomy and pCND were retrospectively analyzed. Univariate and multivariate logistic regression analyses were performed to determine independent risk factors of central lymph node metastasis (CLNM). The decision tree model was used to identify the risk for CLNM in PTMC patients and indications for pCND.

RESULTS

Age, gender, tumor size and location were risk factors for CLNM in cN0 unifocal PTMC patients. The root node of the decision tree model revealed location was the main factor affecting CLNM, and the potential risk of CLNM was the lowest in the intraglandular lesion regardless of gender, age, and tumor size. If lesions located in subcapsular/isthmus lesion, the potential risk was higher and was associated with age, gender, and tumor size.

CONCLUSION

For patients with cN0 unifocal PTMC, regardless of gender, age, or tumor size, the risk of CLNM is the lowest when the lesion is located within the gland. In contrast, the potential risk of CLNM is higher when the lesion is subcapsular or located in the isthmus. In such cases, the decision to perform pCND should be made by integrating the patient's gender, age, and tumor size.