AccScience Publishing / EJMO / Online First / DOI: 10.36922/EJMO025350364
Submit to EJMO
Cite this article
45
Views
Related Info Links
Google Scholar
More by Authors Links
Weihan Cao
Journal Browser
Volume | Year
Issue
Search
Forthcoming Issue
Current Issue
View All
News and Announcements
View All
ORIGINAL RESEARCH ARTICLE

Predictive factors of rVIb lymph node metastasis in papillary thyroid microcarcinoma

Shuyan Zhao1 ,  Xing Peng1 ,  Yuting Li2 ,  Wen Liu1 ,  Weihan Cao2*
Show Less
1 Department of Thyroid Surgery, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
2 Department of Ultrasound, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
EJMO, 025350364 https://doi.org/10.36922/EJMO025350364
Received: 27 August 2025 | Revised: 27 January 2026 | Accepted: 24 February 2026 | Published online: 15 July 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
Download PDF
XML
Cite
Abstract

Introduction: Papillary thyroid microcarcinoma is common, but predictors of metastasis to the right recurrent laryngeal nerve deep lymph nodes (rVIb) are unclear.

Objective: To investigate the predictive factors of lymph node metastasis (LNM) in the rVIb of the right recurrent laryngeal nerve (rRLN) in papillary thyroid microcarcinoma (PTMC) patients, and to examine the correlation between rRLN superficial lymph node (rVIa) and rVIb LNM in these patients.

Methods: Based on rVIb metastasis status, 772 PTMC patients admitted to our hospital from July 2013 to June 2016 were divided into two groups. χ2 test and multivariate logistic regression were used to analyze the risk factors of rVIb metastasis.

Results: The rVIb metastasis rate was 7.1% (55/772). Univariate analysis showed that factors correlated with rVIb metastasis included gender, age, tumor size, tumor location, extrathyroidal invasion, metastasis in the left central area lVI + rVIa, lateral lymph node metastasis (LLNM), concurrent nodular goiter, right tumor location, rVIa LNM, and the number and ratio of metastatic lymph nodes. Multivariate analysis identified male sex, extrathyroidal invasion, rVIa metastasis, LLNM, and right tumor location as independent predictive factors for rVIb.

Conclusion: Male sex, extrathyroidal invasion, rVIa LNM, LLNM, and upper right tumor location were independent risk factors for rVIb metastasis. rVIb metastasis was positively correlated with the number and ratio of rVIa metastatic lymph nodes. The risk of LNM in rVIb increased 8.4-fold when the number of metastatic lymph nodes was ≥2 (compared with <2 metastatic nodes) and 10.9-fold when the metastasis ratio of rVIa nodes exceeded 60% (compared with ≤60% metastatic ratio). Patients at high risk for rVIb metastasis should be considered for more comprehensive rVIb dissection, including central lymph node dissection.

Keywords
Central lymph node dissection
Deep lymph nodes of recurrent laryngeal nerve
Papillary thyroid microcarcinoma
rVIb lymph node metastasis
Funding
This work was supported by the Yunnan Provincial Science and Technology Department Science and Technology Project (grant no. 202301AY070001-009) and the Young Talent Fund of Yunnan Provincial Education Department (grant no. 2025J0188) for Weihan Cao.
Conflict of interest
All authors declare no conflicts of interest. Shuyan Zhao, Xing Peng, Yuting Li, Wen Liu, and Weihan Cao.
References
  1. Kutler DI, Crummey AD, Kuhel WI. Routine central compartment lymph node dissection for patients with papillary thyroid carcinoma. Head Neck. 2012;34:260-263. doi: 10.1002/hed.21728
  2. Lee J, Song Y, Soh EY. Central lymph node metastasis is an important prognostic factor in patients with papillary thyroid microcarcinoma. J Korean Med Sci. 2014;29:48-52. doi: 10.3346/jkms.2014.29.1.48
  3. Cramer JD, Fu P, Harth KC, Margevicius S, Wilhelm SM. Analysis of the rising incidence of thyroid cancer using the Surveillance, Epidemiology and End Results national cancer data registry. Surgery. 2010;148:1147-1152. doi: 10.1016/j.surg.2010.10.016
  4. Hughes DT, Haymart MR, Miller BS, Gauger PG, Doherty GM. The most commonly occurring papillary thyroid cancer in the United States is now a microcarcinoma in a patient older than 45 years. Thyroid. 2011;21:231-236. doi: 10.1089/thy.2010.0137
  5. Zhang L, Wei WJ, Ji QH, et al. Risk factors for neck nodal metastasis in papillary thyroid microcarcinoma: a study of 1066 patients. J Clin Endocrinol Metab. 2012;97:1250-1257. doi: 10.1210/jc.2011-1546
  6. Mehanna H, Al-Maqbili T, Carter B, et al. Differences in the recurrence and mortality outcomes rates of incidental and nonincidental papillary thyroid microcarcinoma: a systematic review and meta-analysis of 21 329 person-years of follow-up. J Clin Endocrinol Metab. 2014;99:2834-2843. doi: 10.1210/jc.2013-2118
  7. White ML, Gauger PG, Doherty GM. Central lymph node dissection in differentiated thyroid cancer. World J Surg. 2007;31:895-904. doi: 10.1007/s00268-006-0907-6
  8. Lee BJ, Lee JC, Wang SG, Kim YK, Kim IJ, Son SM. Metastasis of right upper para-esophageal lymph nodes in central compartment lymph node dissection of papillary thyroid cancer. World J Surg. 2009;33:2094-2098. doi: 10.1007/s00268-009-0149-5
  9. Popadich A, Levin O, Lee JC, et al. A multicenter cohort study of total thyroidectomy and routine central lymph node dissection for cN0 papillary thyroid cancer. Surgery. 2011;150:1048-1057. doi: 10.1016/j.surg.2011.09.003
  10. The NCCN Thyroid Cancer Clinical Practice Guidelines in Oncology (Version 2.2013). Philadelphia: NCCN; 2013.
  11. Chinese Society of Clinical Oncology (CSCO) diagnosis and treatment guidelines for persistent/recurrent and metastatic differentiated thyroid cancer 2018 (English version). Chin J Cancer Res. 2019;31(1):99-116. doi: 10.21147/j.issn.1000-9604.2019.01.06
  12. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26:1-133. doi: 10.1089/thy.2015.0020
  13. Randolph GW. Surgery of the thyroid and parathyroid glands. Philadelphia: Saunders; 2013.
  14. Hwang HS, Orloff LA. Efficacy of preoperative neck ultrasound in the detection of cervical lymph node metastasis from thyroid cancer. Laryngoscope. 2011;121:487-491. doi: 10.1002/lary.21227
  15. Lee DW, Ji YB, Sung ES, et al. Roles of ultrasonography and computed tomography in the surgical management of cervical lymph node metastases in papillary thyroid carcinoma. Eur J Surg Oncol. 2013;39:191-196. doi: 10.1016/j.ejso.2012.07.119
  16. Khokhar MT, Day KM, Sangal RB, et al. Preoperative High- Resolution Ultrasound for the Assessment of Malignant Central Compartment Lymph Nodes in Papillary Thyroid Cancer. Thyroid. 2015;25:1351-1354. doi: 10.1089/thy.2015.0176
  17. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994;97:418-428. doi: 10.1016/0002-9343(94)90321-2
  18. Podnos YD, Smith D, Wagman LD, Ellenhorn JD. The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer. Am Surg. 2005;71:731-734. doi: 10.1177/000313480507100907
  19. Roh JL, Kim JM, Park CI. Central compartment reoperation for recurrent/persistent differentiated thyroid cancer: patterns of recurrence, morbidity, and prediction of postoperative hypocalcemia. Ann Surg Oncol. 2011;18:1312- 1318. doi: 10.1245/s10434-010-1470-9
  20. Zhang L, Liu H, Xie Y, et al. Risk factors and indication for dissection of right paraesophageal lymph node metastasis in papillary thyroid carcinoma. Eur J Surg Oncol. 2016;42:81-86. doi: 10.1016/j.ejso.2015.10.011
  21. Kim YS, Park WC. Clinical predictors of right upper paraesophageal lymph node metastasis from papillary thyroid carcinoma. World J Surg Oncol. 2012;10:164. doi: 10.1186/1477-7819-10-164
  22. Liu Z, Sun M, Xiao Y, Yang J, Zhang T, Zhao Y. Predictors of metastasis to lymph nodes posterior to the right recurrent laryngeal nerve in differentiated thyroid carcinoma: A prospective study. Asian J Surg. 2017;40(4):270-277. doi: 10.1016/j.asjsur.2015.12.003
  23. Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167-1214. doi: 10.1089/thy.2009.0110
  24. Carty SE, Cooper DS, Doherty GM, et al. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid. 2009;19:1153-1158. doi: 10.1089/thy.2009.0159
  25. Kandil E, Noureldine SI, Abbas A, Tufano RP. The impact of surgical volume on patient outcomes following thyroid surgery. Surgery. 2013;154(6):1346-1353. doi: 10.1016/j.surg.2013.04.068
  26. Singer S, Husson O, Tomaszewska IM, et al. Quality-of-Life Priorities in Patients with Thyroid Cancer: A Multinational European Organisation for Research and Treatment of Cancer Phase I Study. Thyroid. 2016;26(11):1605-1613. doi: 10.1089/thy.2015.0640
  27. Park JW, Yoo JS, Yun JK, Kim BH, Noh YW, Kim DJ. An online questionnaire survey on preferred timing for the diagnosis and management of thyroid carcinoma in general population in Korea. Ann Surg Treat Res. 2016;90(6):297- 302. doi: 10.4174/astr.2016.90.6.297
  28. Li G, Li R, Zhong J, et al. A multicenter cohort study of thyroidectomy-related decision regret in patients with low-risk papillary thyroid microcarcinoma. Nat Commun. 2025;16(1):2317. doi: 10.1038/s41467-025-57627-7
  29. Mao LN, Wang P, Li ZY, Wang Y, Song ZY. Risk factor analysis for central nodal metastasis in papillary thyroid carcinoma. Oncol Lett. 2015;9:103-107. doi: 10.3892/ol.2014.2667
  30. Nam IC, Park JO, Joo YH, Cho KJ, Kim MS. Pattern and predictive factors of regional lymph node metastasis in papillary thyroid carcinoma: a prospective study. Head Neck. 2013;35:40-45. doi: 10.1002/hed.22903
  31. Lee YS, Shin SC, Lim YS, et al. Tumor location-dependent skip lateral cervical lymph node metastasis in papillary thyroid cancer. Head Neck. 2014;36:887-891. doi: 10.1002/hed.23391
  32. Bae SY, Yang JH, Choi MY, Choe JH, Kim JH, Kim JS. Right paraesophageal lymph node dissection in papillary thyroid carcinoma. Ann Surg Oncol. 2012;19:996-1000. doi: 10.1245/s10434-011-2144-y
  33. Sadowski BM, Snyder SK, Lairmore TC. Routine bilateral central lymph node clearance for papillary thyroid cancer. Surgery. 2009;146:696-705. doi: 10.1016/j.surg.2009.06.046
  34. Ito Y, Fukushima M, Higashiyama T, et al. Incidence and predictors of right paraesophageal lymph node metastasis of N0 papillary thyroid carcinoma located in the right lobe. Endocr J. 2013;60:389-392. doi: 10.1507/endocrj.EJ12-0362
  35. Zeng H, Zheng R, Guo Y, et al. Cancer survival in China, 2003-2005: a population-based study. Int J Cancer. 2015;136(8):1921-1930. doi: 10.1002/ijc.29227
  36. De Angelis R, Sant M, Coleman MP, et al. Cancer survival in Europe 1999-2007 by country and age: results of EUROCARE--5-a population-based study. Lancet Oncol. 2014;15:23-34. doi: 10.1016/S1470-2045(13)70546-1
  37. Cancer stat fact sheets: Thyroid cancer. Surveillance Epidemiology, and End Results Program. Available from: http://seer.cancer.gov/statfacts/html/thyro.html [Last accessed on June 17, 2025].
Next article in this issue
Share
Back to top
Eurasian Journal of Medicine and Oncology, Electronic ISSN: 2587-196X Print ISSN: 2587-2400, Published by AccScience Publishing
We use cookies on our website to ensure you get the best experience.
Read more about our cookies here
Accept