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Updated: Feb 12, 2026
Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma
Published on: September 15, 2023
Risk factors for lateral and skip lymph node metastasis in adolescents and young adults with papillary thyroid
Min Zhao1, Xinyu Shi2, Runjie Shui1
1Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China.
Background:
Lateral lymph node metastasis (LLNM) and skip lymph node metastasis (SLNM) in papillary thyroid carcinoma (PTC) are generally unpredictable, especially in adolescents and young adults (AYAs). This study aims to investigate the risk factors associated with LLNM and skip SLNM in AYAs with PTC.
Methods:
This retrospective analysis was performed on the medical records of AYAs with PTC who underwent total or near-total thyroidectomy or lobectomy, along with central lymph node dissection (CLND) and lateral lymph node dissection (LLND) at The First Affiliated Hospital of Soochow University from January 2017 to December 2023. Variables identified as significant in the univariate analysis were further assessed using multivariate analysis. Continuous variables deemed significant were analyzed using receiver operating characteristic (ROC) curve analysis to establish optimal cut-off values. Logistic regression analysis was then employed to identify independent risk factors for LLNM and SLNM in AYAs with PTC.
Results:
Among the 545 AYAs with PTC, 480 individuals (88.1%) exhibited LLNM, with 54 of these 480 patients (11.3%) demonstrating SLNM. Univariate and multivariate analyses identified the diameter of the largest tumor [P<0.001, odds ratio (OR) =2.768, 95% confidence interval (CI): 1.544-4.962] and the number of central lymph node metastasis (CLNM) (P=0.001, OR =3.888, 95% CI: 1.701-8.888) as independent predictors for LLNM. Furthermore, the number of LLNM (P=0.007, OR =0.295, 95% CI: 0.122-0.712) was identified as an independent factor for SLNM. ROC curve analysis determined that the optimal cut-off values for the diameter of the largest tumor, the number of CLNM, and the CLNM/ CLND ratio as risk factors for LLNM in AYAs with PTC were 1.1 cm, 3, and 0.3, respectively. Similarly, the optimal cut-off values for the diameter of the largest tumor, the number of LLNM, and the LLNM/LLND ratio for predicting SLNM were 1.2 cm, 5, and 0.2, respectively.
Conclusions:
This study demonstrated that the diameter of the largest tumor greater than 1.1 cm and a number of CLNM equal to or greater than 3 were independent risk factors for LLNM in AYAs with PTC. Additionally, a number of LLNM equal to or less than 5 was identified as a risk factor for SLNM.
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