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Risk Stratification in Papillary Thyroid Microcarcinoma: Clinical Features Predicting Multifocality, Lymph Node

Chih-Chieh Hsu1, Chun-Yi Tsai1, Li-Ching Lin1

  • 1Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.

Cancer Management and Research
|March 20, 2026
PubMed
Summary

Papillary thyroid microcarcinoma (PTMC) risk factors like male gender and lymphovascular invasion increase recurrence risk. Identifying these factors aids in personalized treatment strategies for PTMC.

Keywords:
clinical featureslymph node metastasispapillary thyroid microcarcinomarisk stratificationthyroidectomy

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Area of Science:

  • Endocrinology
  • Oncology
  • Pathology

Background:

  • Papillary thyroid microcarcinoma (PTMC) incidence is rising, now comprising nearly half of all papillary thyroid carcinoma cases.
  • PTMC, defined as ≤1 cm, requires assessment of clinical features and risk factors for effective management.

Purpose of the Study:

  • To assess clinical features and risk factors associated with multifocality, nodal metastasis, and recurrence in PTMC patients.
  • To inform treatment decisions and improve risk stratification for PTMC.

Main Methods:

  • Retrospective analysis of 418 PTMC patients diagnosed between 2005 and 2015.
  • Multivariate logistic regression was used to identify risk factors for adverse outcomes.
  • Sensitivity analysis was conducted on the total thyroidectomy subgroup to mitigate selection bias.

Main Results:

  • Multifocal PTMC (32.1%) was linked to larger tumor size and lymphovascular invasion.
  • Cervical lymph node metastasis (11.5%) correlated with male sex, non-incidental findings, multifocality, and lymphovascular invasion.
  • Recurrence (3.8%) was significantly associated with prior lymph node metastasis; overall survival was 97.6%.

Conclusions:

  • While PTMC is often indolent, specific factors like male gender, non-incidental findings, multifocality, and lymphovascular invasion signal higher risk.
  • These histopathological factors are crucial for guiding PTMC management and considering treatment alternatives like radiofrequency ablation.