Clinical and paraclinical characteristics and factors associated with occult cervical lymph node metastasis in differentiated thyroid cancer cT1N0M0 treated by transoral endoscopic thyroidectomy

Tóm tắt

This cross-sectional study analyzed 218 patients diagnosed with cT1N0M0 papillary thyroid carcinoma (PTC) who underwent transoral endoscopic thyroidectomy vestibular approach (TOETVA) at Hanoi Medical University Hospital between January 2020 and December 2023. Patients were classified into two groups based on postoperative pathology: those with occult cervical lymph node metastasis (oCLNM+) and those without (oCLNM−). The mean patient age was 35.3 years, and the majority were female (96.8%). Tumors had a mean size of 6.9mm, were primarily located in a single lobe (87.2%), and were multifocal in 13.8% of cases. Occult lymph node metastasis was identified in 41.3% of patients. Statistical analysis revealed that tumor size greater than 5.5mm and multifocality were significant predictors of oCLNM, with odds ratios of 2.4 (p = 0.028) and higher likelihood of nodal involvement. The median number of harvested lymph nodes was 4 (range: 0 – 22), and the median number of metastatic nodes was 0 (range: 0 – 17). These findings suggest that, even in patients with a clinically negative neck (cN0), there remains a considerable risk of occult lymph node metastases, especially in cases with multifocal tumors and primary tumor size exceeding 5.5mm.