Central lymph nodes in frozen sections can effectively guide extended lymph node resection for papillary thyroid...

Area of Science:

• Surgical Oncology
• Head and Neck Surgery
• Pathology

Background:

• The extent of lateral neck lymph node dissection (LND) for papillary thyroid carcinoma (PTC) is debated.
• Accurate prediction of lateral neck lymph node metastasis (NLLNM) is crucial for appropriate surgical planning.
• Intraoperative frozen section analysis of central lymph nodes (CLNM) offers a potential tool for real-time assessment.

Purpose of the Study:

• To evaluate the predictive value of central lymph node metastasis (CLNM) detected via frozen sections for NLLNM in PTC.
• To guide clinical decision-making regarding the scope of surgical lymph node dissection in PTC patients.

Main Methods:

• Retrospective analysis of 216 PTC patients who underwent thyroidectomy with intraoperative frozen diagnosis of central LNs and subsequent LND.
• Assessment of the validity and consistency of frozen section diagnoses for CLNM.
• Investigation of the relationship between CLNM characteristics (number, diameter, ratio) and NLLNM.

Main Results:

• CLNM in frozen sections demonstrated a significant association with NLLNM.
• Key predictors for NLLNM included maximum metastatic diameter, total number of metastatic LNs, and the ratio of CLNM.
• Established cut-off values: maximum diameter > 2.050 mm, total number > 5.5, and CLNM ratio > 0.5342.

Conclusions:

• Frozen section analysis of central LNs is a reliable method for predicting NLLNM in PTC.
• Consider lateral neck LND for PTC patients with >5 CLNMs, ≥2 to ≤5 CLNMs and maximum metastatic diameter > 2 mm.
• Findings assist in identifying patients who would benefit from extended lateral neck LND, optimizing surgical strategy.