Effect of Tumor Location on the Risk of Bilateral Central Lymph Node Metastasis in Unilateral 1-4 cm Papillary Thyroid Carcinoma

Abstract

Purpose

Papillary thyroid carcinoma (PTC) has a high incidence of lymph node metastasis (LNM). Our aim was to determine whether tumor location is a useful feature to predict bilateral central lymph node metastasis (CLNM) in unilateral 1–4 cm PTC.

Patients and Methods

Data on unilateral 1–4 cm PTC patients from 2016 to 2019 were collected retrospectively. The clinical and pathological characteristics of the tumors and lymph nodes were analyzed statistically.

Results

The mean patient age was 49.1±12.3 (23–73) years, and the majority were women (n=1334, 75.4%). A total of 1767 patients were analyzed, and 256 (14.5%) had bilateral CLNM. Tumor location was an independent risk factor in predicting bilateral CLNM (p<0.001). The odds of bilateral CLNM were the highest in the near isthmus (OR 6.452, 95% CI: 3.658–11.379, p<0.001). In a multivariate regression model adjusting for other risk factors, near-isthmus tumors had the highest risk of bilateral CLNM (OR 7.319, 95% CI: 3.844–13.933, p<0.001), followed by lower lobe tumors (OR 2.338, 95% CI: 1.315–4.155, p=0.004) and middle lobe tumors (OR 1.845, 95% CI: 1.035–3.291, p=0.038), compared to upper lobe tumors.

Conclusion

Tumor location is an independent risk factor in predicting the risk of bilateral CLNM. Near-isthmus tumors carry the highest risk of bilateral CLNM.

Keywords:

• papillary thyroid carcinoma
• location
• predictive factor
• lymph node metastasis

Acknowledgments

This research was supported by the Key Technology Research and Development Program of Shandong Province (grant No. 2019GSF108072).

Abbreviations

PTC, papillary thyroid carcinoma; LNM, lymph node metastasis; CLNM, central lymph node metastasis; CCND, central compartment neck dissection.

Disclosure

The authors have no conflicts of interest to declare that they are relevant to the content of this article.