This retrospective Korean cohort study looked at the risk factors associated with bilateral lateral lymph node metastases in patients with unilateral papillary thyroid cancer. There were 11 patients who met the inclusion criteria across an 11-year period from 2009 to 2020. The mean age of the patients at the time of surgery was 67 years (range 21 to 79 years). All these patients had a preoperative CT and/or ultrasound with fine needle aspiration to assess the primary tumour and nodal involvement. A range of clinicopathologic characteristics were assessed. Out of the eligible patients, 73% had a primary tumour size of >2cm (with 18% larger than 4cm) and all patients had central compartment metastases. Two patients underwent multiple surgeries during the follow-up period and eight patients received radioactive iodine treatment after surgery. Aggressive subtype, gross extrathyroidal extension, and lymphovascular and perineural invasion, which are known to increase nodal metastases in papillary thyroid cancer, were not present in the majority of patients included in the study. Preoperative CT missed lateral lymph node metastases in one patient, whilst ultrasound detected this in all patients. Although a small number of patients were included in this study, this suggests that there is a higher risk of contralateral lateral lymph node metastases in unilateral papillary thyroid cancer when there is a large tumour or central compartment metastases. Therefore, these patients in particular should have a high suspicion for contralateral lateral lymph node metastases and should be investigated meticulously with ultrasound. Further work into these risk factors with larger patient numbers is warranted to draw more firm conclusions.
Lymph node metastases in papillary thyroid cancer
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