The incidence and predictive factors for central lymph node metastasis in unilateral papillary thyroid carcinoma

Purpose: Although occult central lymph node (LN) metastases in papillary thyroid carcinoma (PTC) are common, the efficacy of prophylactic central lymph node dissection (CLND) remains controversial. This study aimed to investigate the incidence and the risk factors for occult ipsilateral central LN metastasis in patients with unilateral PTC and a clinically negative neck (cN0). Methods: We reviewed a retrospective protocol of 1036 unilateral PTC patients with clinically node-negative necks who have received thyroidectomy and ipsilateral CLND from January 2014 to January 2015. The relationships between metastatic LNs in the ipsilateral central compartment and clinico-pathologic factors such as age, gender, size of primary tumor, number of tumor foci and capsular invasion were analyzed. Results: Occult ipsilateral central LN metastasis was present in 25.3% (262/1036) of these patients with unilateral PTC. Multivariate analysis showed that age < 45 years, male gender, tumor size >1 cm, multiplicity and capsular invasion were independent risk factors for the presence of ipsilateral central LN metastasis (P<0.05). Conclusions: Ipsilateral CLND, performed during the initial thyroid surgery, may be effective in the management of male patients (<45 years) with unilateral PTC with tumor size > 1 cm, multiplicity and capsular invasion.