Related Experiment Video
Updated: Apr 10, 2026
Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma
Published on: September 15, 2023
Clinicopathological Predictors of Contralateral Central Lymph Node Metastasis in Patients With Unifocal Papillary
Huan-Rong Cao1, Rong-Xi Liang1
1Department of Medical Ultrasound, Fujian Medical University Union Hospital, Fuzhou, China.
Objective:
The necessity of prophylactic dissection of contralateral central lymph nodes in patients with unifocal papillary thyroid carcinoma (PTC) remains a contentious issue in clinical practice. This study aimed to identify independent risk factors for contralateral central lymph node metastasis (CLNM) and clarify the clinical value of prophylactic contralateral central lymph node dissection (CLND).
Methods:
A retrospective analysis was conducted on 1437 patients with pathologically confirmed unifocal PTC who underwent thyroidectomy combined with CLND. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of contralateral CLNM. The diagnostic efficacy of the predictive model was evaluated using receiver operating characteristic (ROC) curve analysis, with the area under the curve (AUC) calculated to assess discriminatory ability.
Results:
Among the 1437 unifocal PTC patients, CLNM was detected in 736 cases (51.2%), and ipsilateral paratracheal lymph node metastasis (LNM) was identified in 531 cases (37.0%). CLNM was significantly associated with sex, age, maximum tumor diameter, distance from the capsule, and microcalcifications (all p < 0.05). Ipsilateral paratracheal LNM was closely correlated with age, maximum tumor diameter, distance from the capsule, as well as metastasis to prelaryngeal and pretracheal lymph nodes (all p < 0.05). Contralateral CLNM occurred in 105 patients (7.3%), including 42 patients who exhibited isolated contralateral CLNM in the absence of ipsilateral central compartment involvement. Multivariate analysis demonstrated that larger tumor diameter, microcalcifications, ipsilateral prelaryngeal LNM, and ipsilateral pretracheal LNM were independent predictors of contralateral CLNM (all p < 0.05), whereas age and sex were not (all p > 0.05). The predictive model showed good discriminative performance, with an AUC of 0.824 (95% CI: 0.783-0.865).
Conclusion:
In patients with unifocal PTC, tumor size, microcalcifications, prelaryngeal and pretracheal LNM are independent predictors of contralateral CLNM. The established model demonstrates good diagnostic performance and may provide valuable guidance for preoperative risk stratification and surgical decision-making regarding bilateral CLND.
