Kim Byung-Chang, Pak Shin Jeong, Kwon Douk, Kim Won Woong, Lee Yu-Mi, Sung Tae-Yon, Kim Won Gu, Kim Won Bae, Baek Jung Hwan, Lee Jeong Hyun, Choi Young Jun, Song Dong Eun, Chung Ki-Wook
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Surgery, College of Medicine, Hanyang University, Seongdong-gu, Korea.
Thyroid. 2025 Apr;35(4):415-423. doi: 10.1089/thy.2024.0484. Epub 2025 Mar 31.
The necessity of prophylactic central lymph node dissection (p-CLND) in patients with clinically node-negative papillary thyroid carcinoma (PTC) is unclear. The present study evaluated the central lymph node (LN) metastases status in patients with clinically node-negative PTC on both preoperative thyroid ultrasonography (USG) and neck computed tomography (CT) who underwent p-CLND. This retrospective cohort study included 3002 clinically node-negative patients diagnosed with PTC who had undergone thyroidectomy with p-CLND from January 2000 to September 2022. Clinically node-negative was defined as the absence of suspicious metastatic LNs on preoperative USG and neck CT. Low-risk central LN metastases were defined as LN metastases <2 mm in size with metastatic LNs ≤5. The median follow-up duration was 4.52 (interquartile range [IQR]: 1.6-7.5) years. Of the 3002 patients, 1194 (39.7%) had central LN metastases, whereas 1808 (60.3%) did not. The 1194 patients with central LN metastases included 507 (16.9%) with intermediate-risk metastases and 610 (20.3%) with low-risk LN metastases, with a total of 2428 (80.5%) patients having low-risk LN metastases or no central LN metastases. High-risk metastases were observed in only 77 (2.5%) patients. Of the 584 patients with intermediate-/high-risk metastases, 577 (98.8%) had central LN metastases <1 cm in size, whereas only 7 (1.2%) had central LN metastases ≥1 cm. The disease recurrence rates for the no LN metastases, low-risk LN metastases, and intermediate-/high-risk LN metastases groups were 0.4%, 1.1%, and 1.9%, respectively ( = 0.012). Factors independently associated with intermediate-/high-risk central LN metastases included age <55 years (odds ratio [OR] = 2.29), male sex (OR = 2.33), tumor size >1 cm on USG (OR = 1.94), and the presence of extrathyroidal extension on CT scans (OR = 1.53), with < 0.001 for all factors. Most LNs confirmed after CLND in cN0 PTC patients assessed by USG and CT were either metastasis-free or classified as low-risk metastatic LNs. Furthermore, the majority of metastatic LNs were small in size, typically measuring <1 cm. p-CLND may be unnecessary if preoperative thyroid USG and neck CT show no evidence of central neck LN metastaes.
对于临床淋巴结阴性的乳头状甲状腺癌（PTC）患者，预防性中央淋巴结清扫术（p-CLND）的必要性尚不清楚。本研究评估了术前甲状腺超声（USG）和颈部计算机断层扫描（CT）均显示临床淋巴结阴性的PTC患者接受p-CLND后的中央淋巴结（LN）转移情况。这项回顾性队列研究纳入了2000年1月至2022年9月期间3002例诊断为PTC且接受了甲状腺切除术及p-CLND的临床淋巴结阴性患者。临床淋巴结阴性定义为术前USG和颈部CT未发现可疑转移淋巴结。低风险中央LN转移定义为转移淋巴结大小<2 mm且转移淋巴结数量≤5个。中位随访时间为4.52（四分位间距[IQR]：1.6 - 7.5）年。在这3002例患者中，1194例（39.7%）有中央LN转移，而1808例（60.3%）没有。1194例有中央LN转移的患者中，507例（16.9%）为中风险转移，610例（20.3%）为低风险LN转移，共有2428例（80.5%）患者为低风险LN转移或无中央LN转移。仅77例（2.5%）患者有高风险转移。在584例中/高风险转移患者中，577例（98.8%）的中央LN转移灶<1 cm，而只有7例（1.2%）的中央LN转移灶≥1 cm。无LN转移、低风险LN转移和中/高风险LN转移组的疾病复发率分别为0.4%、1.1%和1.9%（ = 0.012）。与中/高风险中央LN转移独立相关的因素包括年龄<55岁（比值比[OR]=2.29）、男性（OR = 2.33）、USG显示肿瘤大小>1 cm（OR = 1.94）以及CT扫描显示有甲状腺外侵犯（OR = 1.53），所有因素的 < 0.001。经USG和CT评估的cN0 PTC患者在CLND后确认的大多数LN要么无转移，要么被分类为低风险转移LN。此外，大多数转移LN体积较小，通常<1 cm。如果术前甲状腺USG和颈部CT未显示中央颈部LN转移的证据，p-CLND可能不必要。
