Lateral Lymph Node Metastasis Prediction in Papillary Thyroid Cancer Patients with Suspicious Preoperative Imaging Findings

Lateral Lymph Node Metastasis Prediction in Papillary Thyroid Cancer Patients with Suspicious Preoperative Imaging Findings

Purpose: Lateral lymph node metastasis of papillary thyroid cancer (PTC) is indicative oftumor aggressiveness and can determine treatment strategies. However, the role ofprophylactic lateral lymph node dissection in the management of PTC is unclear. This studyevaluated factors predictive of lateral lymph node metastasis in patients with suspiciouslymph node enlargement in preoperative imaging.Methods: This retrospective study included 728 patients with newly diagnosed PTC whounderwent therapeutic surgery. Clinicopathologic results were reviewed, and factorspredictive of lateral lymph node metastasis were analyzed.Results: Of the 242 patients with lymph node metastasis, 50 had lateral lymph nodemetastasis. Lateral lymph node metastasis was associated with sex, tumor size, preoperativethyroid stimulating hormone (TSH) concentration and presence of central lymph nodemetastasis. Among patients with suspicious lateral lymph node metastasis by ultrasonography,high TSH level (odds ratio 3.833, P=0.031) and number of metastatic central lymphnodes (odds ratio 3.68, P=0.025) were significantly predictive of lateral lymph nodemetastasis.Conclusion: High serum TSH level and central lymph node metastasis were predictive oflateral lymph node metastasis in PTC patients with suspicious preoperative imagingfindings. These predictive factors might help reduce unnecessary therapeutic lateral lymphnode dissection.