Predictive factors of contralateral paratracheal lymph node metastasis in unilateral papillary thyroid carcinoma.

Background: Most of unilateral papillary thyroid carcinoma (PTC) metastasize to ipsilateral paratracheal lymph nodes (LNs) while some had contralateral paratracheal LN involved. The aim of this study was to analyze the predictive factors of contralateral paratracheal LN metastasis in unilateral PTC.

Methods: Data on 332 patients with unilateral PTC who underwent total/near total thyroidectomy and bilateral central neck dissection (CND) with/without lateral neck dissection were collected retrospectively. Patients' demographics, the extent of surgeries, and the pathological status of LNs and primary tumor were analyzed.

Results: A total of 332 patients (67 male and 265 female) were included. Contralateral paratracheal LN metastasis was found in 68 (68/332, 20.5%) patients. Tumor size (>1 cm) (P < .001), capsular/extracapsular invasion (P < .001), pretracheal/prelaryngeal LN metastasis (P < .001), lateral neck LN metastasis (P < .001) and ipsilateral paratracheal LN metastasis (P < .001) was significantly associated with contralateral paratracheal LN metastasis on univariate analysis. Multivariate analysis showed that tumor size (>1 cm) (P = .013), capsular/extracapsular invasion (P = .009), pretracheal/prelaryngeal LN metastasis (P = .021) and lateral neck LN metastasis (P = .002) were independent risk factors of contralateral paratracheal LN metastasis.

Conclusions: Primary tumor size >1 cm, capsular/extracapsular invasion, pretracheal/prelaryngeal LN metastasis and lateral neck LN metastasis are predictive factors of contralateral paratracheal LN metastasis in unilateral PTC, which may help to determine the optimal extent of CND in patients with PTC.