Related Experiment Video
Updated: Aug 13, 2026
Computer-Aided Three-Dimensional Visualization in the Treatment of Locally Advanced Thyroid Cancer
Published on: June 9, 2023
Extrathyroidal extension is independently associated with cervical lymph node metastasis in pediatric papillary
Mario Sergio Rocha Macedo1,2, Rodrigo Schuler Honorio3, Willer Feitosa Menezes1
1Serviço de Cirurgia de Cabeça e Pescoço, Hospital Infantil Albert Sabin, Fortaleza, CE, Brasil.
Insights
Extrathyroidal extension (ETE) is a key predictor of cervical lymph node metastasis in pediatric papillary thyroid carcinoma (PTC). This finding suggests closer postoperative surveillance may be warranted for young patients with PTC and ETE.
Area of Science:
- Pediatric Oncology
- Endocrinology
- Surgical Pathology
Background:
- Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy in children.
- Cervical lymph node metastasis (LNM) is frequent in pediatric PTC, impacting prognosis.
- Identifying predictors of LNM is crucial for risk stratification and management.
Purpose of the Study:
- To determine clinicopathologic factors independently associated with LNM in pediatric PTC.
- To guide surgical and postoperative management strategies.
Main Methods:
- Retrospective cohort study of pediatric patients (<18 years) with PTC undergoing total thyroidectomy (2013-2023).
- Analysis of clinical and histopathologic variables according to WHO (2022) and CAP (2023) guidelines.
- Firth's penalized logistic regression used to identify independent predictors of LNM.
Main Results:
- Thirty-two pediatric patients were included; 78% had LNM.
- Extrathyroidal extension (ETE) was significantly associated with LNM in bivariate analysis (p=0.007).
- ETE remained an independent predictor of LNM (OR, 14.29; p=0.028) after adjusting for tumor T stage and lymphatic invasion.
Conclusions:
- ETE is an independent risk factor for cervical lymph node metastasis in pediatric PTC.
- The presence of ETE may necessitate intensified postoperative surveillance.
- These findings aid in refining risk assessment and follow-up protocols for pediatric PTC.
Objective:
To identify clinicopathologic predictors independently associated with cervical lymph node metastasis in pediatric papillary thyroid carcinoma.
Subjects And Methods:
We performed a retrospective cohort including patients younger than 18 years who underwent total thyroidectomy for papillary thyroid carcinoma (PTC) (2013-2023) at a tertiary pediatric hospital in Brazil. Clinical and histopathologic variables were reviewed per World Health Organisation Classification 5th edition (2022) and the College of American Pathologists protocol (2023). Multivariable associations with cervical lymph node metastasis (LNM) were estimated using Firth's penalized logistic regression; discrimination was summarized by the area under the ROC curve (AUC) with 95% bootstrap confidence intervals.
Results:
Thirty-two patients were included (median age, 14 years; 81% female). Cervical LNM occurred in 78%. Extrathyroidal extension (ETE) was associated with cervical lymph node metastasis in bivariate analysis (100% vs 59%; p = 0.007) and remained independently associated with cervical lymph node metastasis after adjustment for tumor T stage and lymphatic invasion (OR, 14.29; 95% CI, 1.28-2028.82; p = 0.028).
Conclusion:
ETE was independently associated with cervical lymph node metastasis in pediatric PTC and may justify closer postoperative surveillance.
