Bayır Ömer, Akan Latif, Kızılgül Muhammed, Uçan Bekir, Karahan Sevilay, Toptaş Gökhan, Aksoy Şevket, Bayır Esra Nur, Sencar Muhammed Erkam, Çakal Erman, Saylam Güleser, Korkmaz Mehmet Hakan
Department of Otolaryngology and Head & Neck Surgery, Etlik City Hospital, Ankara, Turkey.
Department of Endocrinology and Metabolism, Etlik City Hospital, Ankara, Turkey.
Tumori. 2025 Aug;111(4):302-309. doi: 10.1177/03008916251334884. Epub 2025 Jun 3.
To analyze the central lymph node metastasis (CLNM) rates of patients who underwent prophylactic central lymph node dissection (pCLND) with total thyroidectomy for cT1-2N0 papillary thyroid cancer in our clinic, to evaluate the conditions associated with lymph node metastasis, and to examine the necessity of pCLND in these patient groups.
This study includes a retrospective review of the medical data of patients who underwent bilateral/unilateral central lymph node dissection (CLND) (b/uCLND) with total thyroidectomy in our center between 2013 and 2021, whose fine needle aspiration biopsy result was reported as malignant, who were detected as cT1a-1b-2N0 on thyroid and neck ultrasonography.
Of the 251 patients included in the study, 63 (25%) had CLNM (49 (19.5%) ipsilateral and 14 (5.5%) had contralateral CLNM). Twenty-two (20.1%) of 109 patients with cT1a, 30 (28.3%) of 106 patients with cT1b, and 11 (30.5%) of 36 patients with cT2 had CLNM, and metastasis rates increased with increasing cT category. CLNM rates increased with increasing pT category (p=0.005). CLNM was present in 21 (38.8%) of 54 patients (21.5%) with collision tumors, and metastasis rates increased significantly compared to the presence of a single histopathologic tumor (p=0.006). CLNM rates were higher in patients with multicentric tumor localization than in those with unicentric localization (p=0.006).
Multicentricity, bilaterality, capsule invasion, collision tumors and tumors larger than 1 cm increase the risk of CLNM. uCLND for tumors larger than 1 cm, bCLND for tumors larger than 2 cm can be considered. We believe that patients with unilateral CLNM also have an increased risk of contralateral metastasis.
分析我院接受预防性中央区淋巴结清扫术（pCLND）并行全甲状腺切除术的cT1-2N0期甲状腺乳头状癌患者的中央区淋巴结转移（CLNM）率，评估与淋巴结转移相关的情况，并探讨这些患者群体中行pCLND的必要性。
本研究回顾性分析了2013年至2021年在我院接受双侧/单侧中央区淋巴结清扫术（CLND）并行全甲状腺切除术患者的医疗数据，这些患者细针穿刺活检结果报告为恶性，甲状腺及颈部超声检查显示为cT1a-1b-2N0。
纳入研究的251例患者中，63例（25%）发生CLNM（49例（19.5%）为同侧CLNM，14例（5.5%）为对侧CLNM）。109例cT1a患者中有22例（20.1%）发生CLNM，106例cT1b患者中有30例（28.3%）发生CLNM，36例cT2患者中有11例（30.5%）发生CLNM，转移率随cT分期增加而升高。CLNM率随pT分期增加而升高（p=0.005）。54例（21.5%）合并碰撞瘤的患者中有21例（38.8%）发生CLNM，与单一组织病理学肿瘤相比，转移率显著升高（p=0.006）。多中心肿瘤定位患者的CLNM率高于单中心定位患者（p=0.006）。
多中心性、双侧性、包膜侵犯、碰撞瘤及肿瘤直径大于1 cm会增加CLNM风险。对于直径大于1 cm的肿瘤可考虑行单侧CLND，直径大于2 cm的肿瘤可考虑行双侧CLND。我们认为单侧CLNM患者对侧转移风险也会增加。
