Preoperative Prediction of Metastatic Lymph Nodes Posterior to the Right Recurrent Laryngeal Nerve in cN0 Papillary...

Area of Science:

• Oncology
• Surgical Pathology

Background:

• The clinical significance of dissecting lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) in papillary thyroid carcinoma (PTC) without clinical evidence is debated.
• Identifying predictive factors for LN-prRLN can optimize surgical strategies in cN0 PTC patients.

Purpose of the Study:

• To investigate the predictive factors associated with LN-prRLN in clinically node-negative (cN0) papillary thyroid carcinoma (PTC) patients.
• To develop a predictive model for LN-prRLN to guide surgical decision-making in PTC treatment.

Main Methods:

• A retrospective analysis of 251 cN0 PTC patients undergoing thyroidectomy with LN-prRLN dissection between June 2020 and May 2023.
• Univariate and multivariate logistic regression were used to identify predictive factors for LN-prRLN.
• A predictive risk score model was developed based on identified factors.

Main Results:

• The incidence of LN-prRLN was 17.9% (45/251) based on postoperative histology.
• Independent predictors for LN-prRLN included age <55 years, multifocality, microcalcification, and BRAF^V600E mutation.
• A risk score model was established, and surgical complication rates (transient hypoparathyroidism 1.2%, hoarseness 2.0%) were reported.

Conclusions:

• Age <55 years, multifocality, microcalcification, and BRAF^V600E mutation are significant predictors of LN-prRLN in cN0 PTC.
• The developed predictive model can aid in tailoring surgical approaches for PTC.
• Further multicenter research with long-term follow-up is recommended to refine surgical strategies.