Prognostic Significance of Extrathyroidal Extension and Bilaterality in Papillary Thyroid Microcarcinoma: A Comprehensive Multivariate Analysis Publisher



Madadi A ; Shabanimofrad N ; Alibakhshi A ; Keiany F
Source: Indian Journal of Surgery Published:2025

Abstract

Background: Cervical lymph node metastasis (CLNM) impacts prognosis in papillary thyroid microcarcinoma (PTMC). This study evaluates the influence of extrathyroidal extension (ETE), bilaterality, and other factors on CLNM and disease-free survival (DFS). Methods: A retrospective analysis of 220 PTMC patients treated at Imam Khomeini Hospital, Tehran, from March 2022 to March 2024 assessed tumor characteristics and CLNM status. Central lymph node dissection was routinely performed; lateral compartment sampling was conducted only in patients with suspicious nodes on ultrasound (with negative biopsy). Multivariate logistic regression identified CLNM predictors, and Kaplan–Meier analysis evaluated DFS. Predictive accuracy was tested using ROC analysis. Results: CLNM was found in 64 patients (29.1%). Age > 45 years (OR = 5.26, P < 0.001), multifocality (OR = 4.37, P < 0.001), ETE (OR = 5.11, P < 0.001), and bilaterality (OR = 2.68, P < 0.05) were significant predictors. Patients with CLNM, ETE, and bilaterality had poorer DFS (P < 0.001). The model showed strong predictive accuracy (AUC = 0.82). Conclusion: Age > 45, multifocality, ETE, and bilaterality increase CLNM risk and predict poorer DFS, supporting individualized management strategies. © 2025 Elsevier B.V., All rights reserved.