Intraoperative Diagnosis of Central Compartment Lymph Node Metastasis Predicts Recurrence of Patients with Papillary Thyroid Carcinoma and Clinically Node-Negative Lateral Neck and May Guide Extent of Initial Surgery.

Background: Although lymph node (LN) metastasis (LNM) of papillary thyroid carcinoma (PTC) is common, routine prophylactic LN dissection (LND) is still controversial. The purpose of this study was to investigate risk factors for recurrence of PTC with clinically node-negative lateral neck to determine the utility of intraoperative LN biopsy. Materials and methods: This study involved 185 patients with pathologically confirmed PTC and clinically node-negative lateral neck. All patients underwent thyroidectomy with or without ipsilateral or bilateral central LND after intraoperative central LN biopsy. Routine lateral neck LND was not performed. Clinicopathologic and intraoperative findings and post-treatment recurrences were recorded. Univariate and multivariate analyses with Cox-proportional hazards model were used to identify factors associated with recurrence. Results: During a follow-up of 50-96 months, six (3.2 %) patients had recurrences in lateral cervical LNs at a median 28 months (range 7-57 months) after surgery. Overall, 2- and 5-year RFS rates were 98.4 and 96.7 %, respectively. Univariate analyses revealed that tumor size ( P = 0.005), bilaterality ( P = 0.033), T4 disease ( P < 0.001), and intraoperative diagnosis of central LNM ( P = 0.001) were significantly predictive of recurrence. Multivariate analyses showed that T4 disease ( P = 0.049) and intraoperative diagnosis of central LNM ( P = 0.027) were independently predictive of recurrence. Conclusions: Prophylactic lateral neck LND is not advocated for PTC with clinically node-negative lateral neck. Intraoperative LN biopsy may help identify patients at risk for recurrence and those who would benefit from LND. [ABSTRACT FROM AUTHOR]