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Observational Study
. 2025 Mar 28;410(1):109.
doi: 10.1007/s00423-025-03667-y.

The necessity of prophylactic central lymph node dissection in clinically n0 papillary thyroid carcinoma: perspective from the endemic region

Tugba Matlim Ozel  1 , Yigit Soytas  2 , Sezer Akbulut  2 , Aykut Celik  2 , Gorkem Yildiz  2 , Huseyin Karatay  3 , Serkan Sari  2
Affiliations
Observational Study

The necessity of prophylactic central lymph node dissection in clinically n0 papillary thyroid carcinoma: perspective from the endemic region

Tugba Matlim Ozel et al. Langenbecks Arch Surg. .

Abstract

Background: Prophylactic central lymph node dissection (pCND) in papillary thyroid carcinoma (PTC) is still a matter of debate. Therefore, we aimed to identify the factors affecting central lymph node metastasis (CLNM) in patients with clinically node-negative (cN0) PTC.

Methods: This retrospective study included 248 patients with cN0 PTC who underwent total thyroidectomy (TT) or TT + pCND. Clinicopathological associations among CLNM, complication rates and the effect of pCND on staging were assessed. Risk factors (RFs) and the pattern of lymph node metastasis (LNM) in PTC patients were studied via multivariate analysis.

Results: A total of 216 patients underwent pCND, and 58.8% (127/216) had positive CLNM. Male patients, aged < 41 years, and those with lymphatic invasion were identified as RFs for CLNM, with odds ratios of 2.59, 2.26, and 4.09, respectively. Among the 216 patients, 65 (30%) had transient hypoparathyroidism (HPT), and 20 (9.3%) had permanent HPT. Transient recurrent laryngeal nerve (RLN) palsy occurred in 15 (6.9%) patients, and permanent RLN palsy occurred in 3 (1.4%) patients. Over 55 years of age, 46.7% of patients were upstaged according to the American Joint Committee on Cancer (AJCC) TNM staging system, and 14.2% (n = 18) of the 127 patients with CLNM were upgraded according to the American Thyroid Association (ATA) risk stratification system (RSS).

Conclusion: Taken together, in terms of the high incidence rate of CLNM in cN0 PTC patients; We believe that routine pCND, which can be performed with low morbidity rates, is optimal for cN0 PTC patients during their first treatment, especially for those with RFs for CLNM.

Clinical trials number: NCT05873283.

Keywords: Lymph node metastasis; Papillary thyroid carcinoma; Prophylactic central lymph node dissection; Safety; TNM staging.

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Conflict of interest statement

Declarations. Ethical approval: This is retrospective study. The study was approved by the local ethics committee of the Basaksehir Cam and Sakura Health Practices and Research Center (EK- 2021.03.10). Competing interests: The authors declare no competing interests.

Figures

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Fig. 1
ROC curve
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