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<p>Occult lymph node metastases occur in up to 50% of patients with clinically node-negative papillary thyroid carcinoma eligible for thyroid lobectomy. Nevertheless, the 2025-ATA guidelines discourage routine prophylactic ipsilateral central neck dissection in clinically node-negative clinical T1b–T2 low-risk disease. This multicentric retrospective study evaluated the impact of routine ipsilateral central neck dissection on recurrence risk stratification in patients with unifocal clinically node-negative clinical T1b–T2 papillary thyroid carcinoma eligible for thyroid lobectomy. Among 9,028 thyroidectomies performed in four referral centres, 264 patients met the inclusion criteria. Lymph node metastases were found in 135 (51.1%) patients, with extranodal extension in 8.9% of node-positive cases. Median tumour size was 12&#xa0;mm. Final histopathology showed pT1a disease in 88 (33.3%), pT1b in 165 (62.5%), and pT2 in 11 (4.2%). Extrathyroidal extension, vascular invasion, multifocality, and aggressive histologic variants were observed in 12.1, 60.6, 43.2, and 18.9%, respectively. According to the 2025-ATA risk stratification system, excluding pathologic nodal status, 60 (22.7%) patients were low risk, 31 (11.8%) low–intermediate risk, 170 (64.4%) intermediate–high risk, and 3 (1.1%) high risk. After inclusion of nodal status, 54 (20.4%) were low risk, 24 (9.1%) low–intermediate risk, 171 (64.8%) intermediate–high risk, and 15 (5.7%) high risk (<i>p</i> &lt; 0.001). Overall, 8% of patients experienced risk upgrading, and &gt; 70% were classified in higher-risk categories. Pathologic nodal assessment substantially modifies recurrence risk stratification in clinical node-negative T1b–T2 papillary thyroid carcinoma eligible for thyroid lobectomy, supporting routine ipsilateral central neck dissection for staging and tailored surgical decision-making.</p>

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Routine pathological nodal status evaluation significantly modifies 2025 ATA risk category of patients with unifocal cN0 cT1b-T2 PTC eligible for thyroid lobectomy: results from a multicentre international study

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  • 发表日期：

    2026年7月21日

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  • Francesco Pennestrì,
  • Antonio Laurino,
  • Priscilla Francesca Procopio,
  • Fatih Tunca,
  • Emanuela Traini,
  • Carmela De Crea,
  • Kemal Alagol,
  • Giulia Carnassale,
  • Milena Pia Cerviere,
  • Andrea Corsello,
  • Pierpaolo Gallucci,
  • Yalin Iscan,
  • Irem Karatas,
  • Annamaria Martullo,
  • Amelia Mattia,
  • Alfredo Pontecorvi,
  • Francesca Prioli,
  • Maria Pia Ricciato,
  • Esther Diana Rossi,
  • Marco Raffaelli

摘要

Occult lymph node metastases occur in up to 50% of patients with clinically node-negative papillary thyroid carcinoma eligible for thyroid lobectomy. Nevertheless, the 2025-ATA guidelines discourage routine prophylactic ipsilateral central neck dissection in clinically node-negative clinical T1b–T2 low-risk disease. This multicentric retrospective study evaluated the impact of routine ipsilateral central neck dissection on recurrence risk stratification in patients with unifocal clinically node-negative clinical T1b–T2 papillary thyroid carcinoma eligible for thyroid lobectomy. Among 9,028 thyroidectomies performed in four referral centres, 264 patients met the inclusion criteria. Lymph node metastases were found in 135 (51.1%) patients, with extranodal extension in 8.9% of node-positive cases. Median tumour size was 12 mm. Final histopathology showed pT1a disease in 88 (33.3%), pT1b in 165 (62.5%), and pT2 in 11 (4.2%). Extrathyroidal extension, vascular invasion, multifocality, and aggressive histologic variants were observed in 12.1, 60.6, 43.2, and 18.9%, respectively. According to the 2025-ATA risk stratification system, excluding pathologic nodal status, 60 (22.7%) patients were low risk, 31 (11.8%) low–intermediate risk, 170 (64.4%) intermediate–high risk, and 3 (1.1%) high risk. After inclusion of nodal status, 54 (20.4%) were low risk, 24 (9.1%) low–intermediate risk, 171 (64.8%) intermediate–high risk, and 15 (5.7%) high risk (p < 0.001). Overall, 8% of patients experienced risk upgrading, and > 70% were classified in higher-risk categories. Pathologic nodal assessment substantially modifies recurrence risk stratification in clinical node-negative T1b–T2 papillary thyroid carcinoma eligible for thyroid lobectomy, supporting routine ipsilateral central neck dissection for staging and tailored surgical decision-making.