Extent of Thyroidectomy and Lymphadenectomy in 254 Patients With Papillary Thyroid Microcarcinoma: A Single-Institution Experience

No agreement has been made about the optimal extent of thyroidectomy or lymph node dissection in papillary thyroid microcarcinoma (PTMC). Our aim was to find out the factors associated with the presence of lymph node metastases in the patients with PTMC and to discuss the extent of thyroidectomy and lymphadenectomy. A total of 254 patients with PTMC (212 women, 42 men; age 14 to 85 years, median 47 years) were treated at our institute between 1975 and 2007. Lymph node metastases were confirmed in 59 patients (23%) by histopathology. The median observation time was 56 (range, 1-397) months, and the recurrence was diagnosed in seven patients. Modified radical neck dissection and central neck dissection were performed in 55 and 30 patients, respectively. The data on the clinicopathological characteristics of patients and treatment were collected. An incidental PTMC was diagnosed in 107 patients postoperatively. In none of them was a lymph node metastasis or tumor recurrence detected. Preoperatively, an overt PTMC was diagnosed in 147 patients. Clinically manifest metastases were diagnosed in 59 (40%) of them: in 51 preoperatively, and in 8 during the surgical procedure. In 147 patients who had preoperative diagnosis of PTMC, the factors that correlated (P < 0.05) with the presence of lymph node metastases were sex, age, and tumor type. The patients with high-risk PTMC with preoperatively confirmed lymph node metastases had a higher recurrence rate than those with low-risk PTMC without preoperatively detectable lymph node metastases; therefore, careful therapeutic node dissection is necessary in high-risk patients.