Should central lymph node dissection be considered for all papillary thyroid microcarcinoma?
BACKGROUND
Central lymph node dissection (CLND) in patients with papillary thyroid microcarcinoma (PTMC) is still controversial. The aim of this study was to examine the risk factors and the incidence of central lymph node metastases (CLNMs) in patients with PTMC who underwent thyroidectomy and CLND.


METHODS
Between 2002 and 2013, 613 patients were enrolled who underwent thyroidectomy with routine CLND for PTMC at the Korea University Medical Center, Ansan Hospital and risk factors and the incidence of CLNM were analyzed. In addition, we also evaluated the complications after thyroidectomy with CLND.


RESULTS
Out of 613 patients, 239 (39.0%) were found to have CLNM. Male sex (p = 0.012), tumor size ≥ 0.5 cm (p = 0.001), capsular invasion or extrathyroidal extension (p = 0.029), and multifocality (p = 0.004) were independent risk factors for CLNM. Among the 69 patients who had PTMC without these risk factors, CLNM was identified in 12 (17.4%). In this study group, two (0.3%) had permanent recurrent laryngeal nerve injury, two (0.3%) had persistent hypocalcemia, and two (0.3%) developed postoperative hemorrhage.


CONCLUSIONS
CLNM in PTMC is highly prevalent in male sex, tumor size ≥ 0.5 cm, extrathyroidal extension, and multifocality. Even in PTMC patients without these risk factors, the incidence of CLNM is rather higher than expected, and the complication rate of thyroidectomy with CLND is acceptable. Thus, CLND should be considered in all patients with PTMC.
Department of Breast Endocrine Surgery, Korea University Medical Center, Seoul, Republic of Korea; Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea.
Young Woo
YW
Chang
Department of Breast Endocrine Surgery, Korea University Medical Center, Seoul, Republic of Korea; Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea.
Hwan Soo
HS
Kim
Department of Breast Endocrine Surgery, Korea University Medical Center, Seoul, Republic of Korea; Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea.
Hoon Yub
HY
Kim
Department of Breast Endocrine Surgery, Korea University Medical Center, Seoul, Republic of Korea; Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea.
Jae Bok
JB
Lee
Department of Breast Endocrine Surgery, Korea University Medical Center, Seoul, Republic of Korea; Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea.
Jeoung Won
JW
Bae
Department of Breast Endocrine Surgery, Korea University Medical Center, Seoul, Republic of Korea; Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea. Electronic address: gsson@korea.ac.kr.
Gil Soo
GS
Son
D000328:Adult; D002291:Carcinoma, Papillary / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy; D016896:Treatment Outcome
central lymph node; papillary thyroid cancer; papillary thyroid microcarcinoma