A Retrospective Assessment of Prognostic Preoperative Signs in Metastases to the Central Group of Lymph Nodes in Papillary Thyroid Carcinoma

Introduction. Papillary thyroid carcinomas (PTC) are considered relatively common occult and incidental findings, with generally good prognosis and favorable outcome. Despite this, metastases to the central lymph nodes (CLN) occur frequently and are associated with adverse consequences and prognosis for patients. The aim of the present study was to assess the frequency of central lymph node metastases in patients with papillary thyroid carcinoma staged as pT1a over a 10-year period, and to identify possible risk factors associated with the presence of CLN metastases. Materials and methods. A retrospective cohort study was conducted at the Interterritorial Endocrine Surgery Center, Krasnodar. Between January 2010 and January 2022, thyroidectomy was performed in 3013 patients. A total of 2818 patients were excluded from the study following thyroidectomy due to final benign histological findings, age under 18 years, follicular, medullary, anaplastic carcinoma, mixed-type thyroid carcinoma, tumor size > 1 cm, and stages pT1b–pT4. The analysis included 195 patients with pT1a papillary thyroid carcinoma. All patients underwent thyroidectomy and prophylactic or therapeutic standardized lymph node dissection. Results and discussion. Multivariate analysis demonstrated that central lymph node metastases were present in a significant number of cases in patients with PTC after organ preservation surgery. Therefore, in order to choose the most effective surgical treatment, careful preoperative evaluation is warranted for patients without confirmed lymph node metastases (N0). Conclusion. The results of our study indicate that CLN metastases are present in a considerable proportion of patients with PTC after thyroid resection. Combining these findings with preoperative ultrasonography may assist clinicians in accurately assessing whether CLN metastases are present in patients with PTC, thereby facilitating appropriate surgical planning for each individual patient.

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