| Part1Association between multifocality and cervical lymph node metastasis in papillary thyroid microcarcinoma:a systematic review and meta-analysisStudies have shown multifocality significantly increases lymph node metastasis risk in papillary thyroid carcinoma, but the association in microcarcinoma is controversial. This is a systematic review and meta-analysis of the role of multifocality in papillary thyroid microcarcinoma. A systematic search was performed in databases to identify all original articles employing the association between multifocality and lymph node metastasis among papillary thyroid microcarcinomas. Eligible studies were carefully reviewed and analyzed. A meta-analysis of fourteen publications with a total3549papillary thyroid microcarcinomas demonstrated that multifocality was significantly associated with LNM risk with an odds ratio of1.7(95%confidence interval,1.1-2.7). Patinets who have multifocal papillary thyroid microcarcinoma are at high risk of lymph node metastasis. Total thyroidectomy associated with routine central neck dissection may be the best surgical approach.Part2Risk for cervical lymph node metastasis among papillary thyroid microcarcinomaTo identify high-risk papillary thyroid microcarcinoma (PMC) inclined to lymph node metastasis (LNM), we conducted this hospital-based retrospective study. Patients who underwent total thyroidectomy with central neck dissection and had a pathological diagnosis of PMC between2003and2010at Wuhan Union Hospital were included in this study. The frequency of LNM was retrospectively analyzed according to the clinicopathological features. For multifocal lesions, total tumor diameter was calculated as the sum of the maximal diameter of each lesion. Age, gender, multifocality, capsular invasion and local infiltration were independent factors that associated with cervical LNM in PMC. The proportion of LNM was similar between multifocal PMCs with total tumor diameter less than or equal to1cm and unifocal tumors with diameter less than or equal to lcm (37.5vs.30%, P=0.463). LNM frequency was56.89%among multifocal PMC with total tumor diameter greater than1cm but less than2cm, and64.9%among unifocal tumors with diameter greater than1cm but less than2cm with no significant difference between the two groups (P=0.330). However, LNM frequency was significantly higher in multifocal PMCs with total tumor diameter greater than1cm than unifocal tumors with diameter less than or equal to1cm (60.4vs.30%,P<0.001). Our study indicated that it was multifocality along with total tumor diameter that significantly affected LNM risk in PMC patients.Part3A reliable and easy-to-use scoring system facilitating selection of prophylactic central neck dissection among papillary thyroid microcarcinomas based on the retrospective studyNumerous classifications have been developed to determine prognositic factors for patients with papillary thyroid carcinoma, including the TNM (tumor, node, metastasis) classification by the International Union Against Cancer, the AGES (age, grade, extent, and size) classification by Mayor’s clinic, and EORTC prognostic index by the European Organization for Research and Treatment of Cancer. We conducted this study to provide tables that allow thyroid surgeons to easily calculate a thyroid microcarcinoma patient’s risks of cervical lymph node metastasis preoperatively. A combined analysis was carried out of individual patient data from437papillary thyroid microcarcinoma patients who underwent thyroid surgery for papillary thyroid microcarcinoma during2003-2012in Wuhan Union Hospital. A simple scoring system was derived based on5clinical and pathological factors:sex, age, number of tumors, the maximum tumor size, total tumor diameter. The probabilities of developing cervical lymph node metastasis from less than10%to almost100%among groups based on the score. With the scoring system, the urologist can discuss the different options with the patient to determine the most appropriate treatment.Part4A reliable and easy-to-use scoring system facilitating selection of prophylactic central neck dissection among papillary thyroid microcarcinomas:a prospective studyWe conducted this prospective study to evaluate the above scoring system for predicting cervical lymph node metastasis among papillary thyroid microcarcinoma. In this prospecive study, we assessed104patients with papillary thyroid micocarcinoma and to determine the predictive accuracy of the above scoring system applicable to the study population. With regard to cervical lymph node metastasis, the difference between the respective stages and/or risk groups was highly significant. The probability to develop cervical lymph node metastasis among high risk group, namely those scoring more than6was more than90%. However, the probability to develop cervical lymph node metastasis among middle risk group, namely those scoring more than4but less than6, was around40%. Moreover, among each risk group, the probability to develop cervical lymph node metastasis was increased along with increasing score. In conclusion, the scoring system for predicting cervical lymph node metastasis among papillary thyroid microcarcinoma is reliable and accurate to facilitate thyroid surgeons choosing the most appropriate surgical procedure. Moreover, the individual factors such as age, sex, tumor size are easy to obtain and generally available. |
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