Papillary thyroid microcarcinoma (PTMC) generally has a favorable prognosis. Early central lymph node metastasis (CLNM) can significantly impact treatment strategy and prognosis. However, CLNM lacks typical ultrasound features. Accurate preoperative prediction of CLNM remains challenging. This study aims to develop and validate a high-accuracy tool for preoperatively assessing the risk of lymph node metastasis in PTMC patients. We retrospectively analyzed clinical and ultrasound data from 534 PTMC patients who underwent initial thyroidectomy with central lymph node dissection. Patients were randomly divided into training (n=373) and validation (n=161) cohorts. We calculated high-throughput radiomics features, including tumor size, tumor shape, margin, capsular contact, microcalcifications, and peritumoral echogenicity features. A combined feature selection strategy was then used to identify features with the greatest discriminatory power for lymph node status. A Logistic Regression machine classifier was employed to build and validate the prediction model. Additionally, ultrasound ACR TI-RADS and clinical variables were evaluated. Univariate and multivariate logistic regression was used to identify independent predictors, which were further incorporated into a nomogram model. The area under the operating characteristic curves (AUCs) was used to draw comparisons between different models and the decision curve analysis was conducted to assess their clinical utility. In the clinical model based solely on clinical and conventional ultrasound features, multivariate analysis identified five independent predictors of CLNM: age <46.5 years, male sex, capsular contact ≥50%, peritumoral hyperechogenicity and heterogeneous echotexture (AUC: 0.857 in the training set and 0.840 in the validation set). By further integrating a radiomics score with all univariately significant clinical variables, a combined clinical-radiomics nomogram was developed. In this combined model, age, transverse diameter of tumor, capsular contact, peritumoral echo changes, and the radiomics score were identified as independent predictors. The combined model achieved an improved AUC of 0.900 in the validation set, demonstrating superior predictive performance and higher clinical net benefit than the clinical model alone. The proposed clinical-radiomics nomogram, which incorporates conventional ultrasound features and radiomics signatures, outperforms the standalone clinical model in predicting CLNM. This non-invasive approach provides superior pre-operative risk assessment in optimizing treatment strategies for PTMC patients.

Thyroid cancer is one of the most common endocrine malignancies worldwide. Surgical resection remains the standard care; however, minimally invasive approaches are increasingly being investigated for patients with low-risk cases, particularly papillary thyroid microcarcinoma (PTMC). This review summarizes current evidence on the use of radiofrequency ablation (RFA) in the management of differentiated thyroid carcinoma, with a primary focus on papillary thyroid carcinoma. 27 key publications were analyzed, including international guidelines, meta-analyses, and prospective and retrospective studies. Available data indicate that RFA achieves local tumor control and recurrence-free survival rates comparable to those of surgical management in appropriately selected low-risk patients, while significantly reducing procedure-related morbidity and preserving thyroid function. The technique demonstrates particular efficacy in patients with solitary tumors of up to 1 cm (T1aN0M0) without evidence of metastasis. This review provides a comprehensive evaluation of accumulated clinical data, direct comparison between RFA and thyroid surgery, and an analysis of long-term outcomes as reflected in major guidelines from 2022–2025. Current evidence suggests that RFA represents an emerging organ-preserving strategy that maintains oncologic efficacy in low-risk papillary thyroid carcinoma. Further randomized trials are required to define its role within standardized treatment algorithms.

Papillary thyroid microcarcinomas (PTMC) are defined by the World Health Organisation (WHO) as tumours measuring ≤ 10 mm. Incidental PTMCs, or lesions discovered postoperatively on histological examination, are less extensively studied compared with lesions diagnosed preoperatively through cytology, particularly in terms of demographics, histopathological features and long-term outcomes. This study aimed to compare outcomes between these patients. A single-centre retrospective cohort analysis of data from the St. James's University Hospital Head and Neck tumour board spanning from 2013 to 2023 was conducted. A total of 152 patients diagnosed with PTMCs and neck nodes ≤ 1 cm were identified during this period. Of these, 55 were incidental and 47 were non-incidental PTMCs included in the final analysis. Significant differences were observed between the two subgroups in terms of the size of the largest tumour focus (7.8 mm vs. 3.9 mm, p < 0.001), the presence of aggressive histologic variants (9.2% vs. 0.9%, p = 0.002) and the frequency of neck dissections (8.8% vs. 0.0%, p < 0.001). However, no recurrences occurred in either group. This comprehensive 10-year retrospective review found few differences in the presentation of incidental and non-incidental microcarcinoma, with low recurrence rates and excellent outcomes. These findings, with overall low numbers, provide hypothesis-generating evidence that this group may be suitable for discharge to primary care for further follow-up.

The incidence of pediatric thyroid cancer increases sustainably in the past years. Pediatric thyroid cancer is different from adult thyroid cancer in pathophysiology, clinical characteristics and others, which determines the different treatment methods for pediatric thyroid cancer and adult patients. In order to avoid the overtreatment of younger patients, this study aims to explore the effect of clinically pathological features on postoperative recurrence of thyroid cancer in younger patients. A total of 234 patients ≤25 years and 311 patients >25 years of age with papillary thyroid carcinoma from Medical University Cancer Institute and Hospital were enrolled in the retrospective study. We retrospectively analyzed thyroid cancer patients, stratified by age (<18, 18-25, >25 years). Clinicopathological features were compared using log-rank tests; multivariable Cox regression identified recurrence predictors, and Kaplan-Meier analyses assessed recurrence-free survival (RFS). Patients aged <18 and 18-25 years showed comparable clinical characteristics (only sex distribution differed, P=0.02), supporting a unified children, adolescents, and young adult (CAYA) cohort (≤25 years). CAYA patients exhibited higher rates of bilateralism, multifocality, papillary thyroid microcarcinoma, extrathyroidal extension, lymphatic metastasis, and recurrence. Lymphatic metastasis [Exp(B) =6.818, P=0.009] and lateral cervical lymph node (LN) dissection [Exp(B) =3.044, P=0.005] were independent recurrence predictors. Lymphatic metastasis (presence, ≥5 nodes, or lateral location) correlated with poorer RFS (P≤0.006). LN metastasis is an important risk factor for postoperative recurrence in CAYA patients, suggesting that preoperative attention should emphasize the assessment of LN metastasis, including the number and area.

The rate of cervical central lymph node metastasis (CLNM) in papillary thyroid microcarcinoma (PTMC) patients is relatively high. It is controversial that patients with clinically lymph node (LN)-negative entail prophylactic central neck dissection (pCND). The objective of this study was to develop and validate a predictive nomogram incorporating both radiomics signatures and ultrasonic features to aid in the individualized, preoperative assessment of central cervical LN metastasis in patients with clinically node-negative PTMC. A total of 266 patients, each with a single malignant thyroid nodule, were enrolled and randomly split into a training set and a validation set at a ratio of 7:3. Radiomics signatures were constructed by applying the least absolute shrinkage and selection operator (LASSO) regression to features extracted from two-dimensional (2D) ultrasound (US) images. We then built three logistic regression models using clinical and US features (model 1), the radiomics signatures (model 2), and a combination of both (model 3). Finally, we presented the combined model as a nomogram and assessed its clinical utility with decision curve analysis (DCA). The highest diagnostic performance was achieved by model 3, which showed robust discrimination in the training [area under the curve (AUC) =0.892], internal validation (AUC =0.772), and external validation (AUC =0.842) sets, outperforming model 1 and model 2. A nomogram combining radiomics analysis based on US images of PTMC with clinical and imaging features showed a better diagnostic performance than conventional US imaging features alone in predicting metastatic central cervical LNs preoperatively in clinically LN-negative patients with PTMC and could assist in making advice associated with treatment plan.

Introduction. Papіllary thyroіd mіcrocarcіnoma (PTMC) іs the most common form of dіfferentіated thyroіd cancer and usually has a favorable prognosіs; however, іn 8-15% of cases іt demonstrates features of aggressіveness [1, 2]. The bіologіcal behavіor of the tumor іs determіned not only by іts sіze but also by clіnіcal and іnstrumental characterіstіcs that reflect іnvasіve potentіal and the rіsk of regіonal metastasіs [2, 3]. Key predіctors of an aggressіve course іnclude young age, male sex, hypoechogenіcіty, іll-defіned margіns, the presence of mіcrocalcіfіcatіons, as well as changes іn the expressіon of іmmunocytochemіcal markers-cytokeratіn-17 (CK17) and thyroіd peroxіdase (TPO) [2-4, 7-9]. Іncreased CK17 expressіon and decreased TPO expressіon correlate wіth a lower degree of tumor dіfferentіatіon and a more aggressіve clіnіcal behavіor [4-6]. Accordіng to the recommendatіons of the Amerіcan Thyroіd Assocіatіon (ATA, 2015), takіng іnto account later offіcіal posіtіon statements, consensus documents and clіnіcal updates of the ATA, as well as the current recommendatіons of the Natіonal Comprehensіve Cancer Network (NCCN 2024-2025), hemіthyroіdectomy may be a suffіcіent radіcal іnterventіon іn the absence of sіgns of aggressіveness, whіch underscores the need for comprehensіve preoperatіve rіsk stratіfіcatіon of patіents [3, 4, 7]. Aіm. To perform a comprehensіve assessment of papіllary thyroіd mіcrocarcіnoma characterіstіcs, іn partіcular the expressіon of CK17 and thyroіd peroxіdase (TPO) іn tumor aspіrates, іn order to determіne the prognostіc value of these markers when selectіng surgіcal treatment tactіcs. Materіals and methods. The study was conducted at the Munіcіpal Nonprofіt Enterprіse «Precarpathian Clinical Oncology Centre» (2024-2025) and іncluded 58 patіents wіth cytologіcally confіrmed PTMC (sіze ≤10 mm). Clіnіcal, ultrasound, laboratory, and іmmunocytochemіcal testіng for CK17 and TPO was performed. Patіents were stratіfіed іnto two groups accordіng to features of potentіal aggressіveness. Results. Sіgns of an aggressіve course were detected іn 21 patіents (36.2%), who were assіgned to the hіgh-rіsk group A; these іncluded cases wіth mіcrovascular іnvasіon, extrathyroіdal extensіon, and/or lymphogenous metastasіs. Іn thіs group, hіgh CK17 expressіon (≥10%) and reduced TPO expressіon (&lt;25%) were sіgnіfіcantly more frequent, reflectіng a lower degree of tumor dіfferentіatіon and hіgher іnvasіve potentіal (p&lt;0.05). Іn 37 patіents (63.8%) assіgned to group B, no sіgns of aggressіveness were detected; the dіsease was characterіzed by favorable clіnіcal and ultrasound features and a preserved іmmunocytochemіcal profіle. The combіnatіon of clіnіcal, ultrasound, and іmmunocytochemіcal crіterіa ensured a justіfіed choіce of the extent of surgery and made іt possіble to avoіd overtreatment, іn partіcular unjustіfіed extensіon of surgіcal іnterventіon іn patіents of group B. Conclusіons. Іmmunocytochemіcal markers CK17 and TPO are іnformatіve predіctors of an aggressіve course of PTMC and іncrease the accuracy of preoperatіve prognosіs. The use of personalіzed surgіcal tactіcs wіth determіnatіon of CK17 and TPO reduces the rіsk of an excessіve extent of surgіcal іnterventіon. Іn addіtіon, іn patіents of group B after hemіthyroіdectomy there іs no need for suppressіve therapy, and іn some patіents for replacement therapy, whіch provіdes a pronounced economіc and socіal effect (reductіon of costs for medіcatіons, laboratory monіtorіng, and іmprovement of qualіty of lіfe).

577 Clinicopathological and Molecular Profile of Papillary Thyroid Microtumors and Microcarcinomas in Colombian Patients Using Porto Criteria

Preoperative risk stratification for papillary thyroid cancer (PTC) is a significant clinical challenge as current systems primarily rely on postoperative pathology, limiting their utility for initial treatment planning. This study aimed to evaluate the effectiveness of using circulating tumor cells (CTC) as a noninvasive liquid biopsy tool to stratify patient risk preoperatively. We conducted a prospective study evaluating preoperative CTC levels in 210 patients diagnosed with PTC. A dual-threshold model was developed to analyze the diagnostic performance of CTC counts. The study particularly focused on the papillary thyroid microcarcinoma (PTMC) subgroup (n = 100) to address clinical uncertainty with regard to active surveillance versus definitive therapy. Patients were monitored over a median follow-up period of 44 months to assess progression-free survival (PFS) and long-term prognostic outcomes. The dual-threshold model demonstrated excellent diagnostic performance. A cutoff of ≥2 CTCs effectively identified high-risk patients with 93.2% specificity and 88.2% positive predictive value (PPV). In the PTMC cohort, a CTC count <2 reliably identified low-risk patients suitable for active surveillance (negative predictive value = 94%), whereas a count ≥2 pinpointed those with high-risk features warranting surgery (specificity = 96.4% and PPV = 80%). Prognostic analysis revealed that CTC-negative patients had improved PFS. This was most significant in the PTMC subgroup, in which the CTC-negative cohort remained recurrence free and showed significantly longer PFS compared with CTC-positive cases (HR = 0.035; 95% confidence interval, 0.002-0.726; P = 0.030). Preoperative CTC detection enables precise risk stratification for patients with PTC. This liquid biopsy approach allows clinicians to personalize therapy-confidently selecting conservative management for low-risk individuals and recommending aggressive treatment for high-risk patients-thereby optimizing clinical decision-making and long-term outcomes.

Lateral lymph node metastasis (LLNM) increase the risk of local recurrence and secondary surgery, posing a significant physical, psychological and economic burden on patients with papillary thyroid microcarcinoma (PTMC). Therefore, it is necessary to analyze the clinicopathological features and risk factors of recurrence in these cN1b PTMC patients,thereby guiding risk-stratified clinical management. A retrospective cohort of 246 patients with cN1b PTMC who underwent primary surgery at Zhejiang Cancer Hospital (January 2008-December 2017) was analyzed. Clinicopathological data and long-term follow-up outcomes were collected. Univariate and multivariate logistic regression analyses were used to identify predictors of skip lateral lymph node metastasis (SLNM) and recurrence, while Kaplan-Meier survival analysis with log-rank tests was used to compare recurrence-free survival between subgroups.Sample size calculation was performed to ensure statistical power, and temporal stratification was used to mitigate retrospective bias. Multivariate logistic regression identified two independent predictors of SLNM: maximum tumor diameter ≤ 5mm (OR = 2.84) and absence of intrathyroidal dissemination (OR = 16.19). Notably, SLNM was not associated with recurrence or disease-specific survival (DSS). During follow-up, 14 patients had lymph node recurrence and 6 patients had local recurrence, 2 patients died of thyroid cancer. Multivariate analysis confirmed three independent recurrence predictors: extrathyroidal extension (ETE, OR = 4.06, 95% CI 1.14-14.38), upper-pole tumor location (OR = 3.58, 95% CI 1.34-9.58), and intrathyroidal dissemination (OR = 2.88, 95% CI 1.14-7.28). Kaplan-Meier analysis showed significantly higher recurrence rates in patients with ETE (21.9% vs. 6.1%, P < 0.05), upper-pole tumors (13.8% vs. 4.6%, P < 0.05), and intrathyroidal dissemination (18.4% vs. 6.3%, P < 0.05). In cN1b PTMC, SLNM is independently associated with tumor size ≤ 5mm and absence of intrathyroidal dissemination but not with recurrence or DSS, suggesting it should be a key target for preoperative imaging evaluation rather than a poor prognostic factor. ETE is one of the most important independent recurrence risk factors, alongside upper-pole location and intrathyroidal dissemination-its effect magnitude requires cautious interpretation due to a wide confidence interval. A risk-stratified strategy is supported: patients with these high-risk features may consider more radical treatment and intensified postoperative surveillance. This study provides evidence-based guidance to improve disease-free survival in cN1b PTMC patients.

This Viewpoint discusses thermal ablation as a treatment option for papillary thyroid microcarcinoma, including technical challenges, patient perceptions, and costs compared with active surveillance.

Prognosis and surgical outcomes of isthmusectomy for cN0 solitary Low-Risk papillary thyroid microcarcinoma in the isthmus.

Patient: Female, 68-year-oldFinal Diagnosis: Collision tumor composed of papillary thyroid carcinoma, infiltrative follicular subtype, and a medullary thyroid microcarcinoma • synchronous papillary, medullary, and anaplastic thyroid carcinomasSymptoms: Enlarging neck mass • neck painClinical Procedure: —Specialty: Endocrinology and Metabolic • Oncology • Otolaryngology • SurgeryObjective: Rare coexistence of disease or pathologyBackgroundPapillary thyroid carcinoma (PTC) is the most common form of thyroid cancer, while medullary thyroid carcinoma (MTC) and anaplastic thyroid carcinoma (ATC) are far less common. ATC is the most aggressive form, contributing to the majority of thyroid cancer-related deaths. While the coexistence of different pathological types of thyroid malignancies has been reported, including combinations of ATC, PTC, and poorly differentiated thyroid carcinoma, the detection of ATC within extrathyroidal metastatic lymph nodes remains exceedingly rare and of notable clinical significance.Case ReportWe present a 68-year-old woman evaluated for a progressively enlarging right-sided neck mass which was apparat in clinical examination, with no other associated symptoms or signs. Nasopharyngoscopy was unremarkable. Imaging studies revealed a large cystic and necrotic mass in the right carotid space compressing the internal jugular vein. A core needle biopsy confirmed metastatic PTC. The patient underwent total thyroidectomy with right radical neck dissection. Histopathological evaluation reported a unique combination: a collision tumor composed of PTC, infiltrative follicular subtype, and MTC. Immunohistochemistry confirmed the diagnoses, and molecular analysis revealed a BRAF mutation. The patient was not a candidate for radioactive iodine therapy due to the aggressive nature of the anaplastic component. Thus, she was referred for targeted cancer therapy.ConclusionsThis case highlights the synchronous occurrence of PTC, MTC, and ATC in a single patient. The localization of anaplastic transformation solely to lymph nodes without thyroidal involvement underscores the importance of meticulous histopathological assessment. Comprehensive diagnostic workup and molecular profiling are critical in guiding treatment for such complex presentations.

Chronic lymphocytic thyroiditis (CLT) is recognized as the most prevalent inflammatory disorder of the thyroid, while the B-Raf proto-oncogene, serine/threonine kinase (BRAF) V600E mutation is the most frequently identified genetic alteration in papillary thyroid carcinoma (PTC). This study aims to explore the relationship between CLT and BRAF V600E mutation and to assess their combined impact on tumor behavior across different tumor sizes. We conducted a retrospective analysis of clinical and pathological data from 1474 patients who underwent surgical treatment for PTC. Univariate and multivariate logistic regression analyses were applied to identify independent factors influencing tumor characteristics. CLT was detected in 27.5% (405/1474) of the PTC cases. Multivariate analysis revealed that CLT was significantly associated with female sex; simultaneously, CLT was significantly negatively associated with BRAF V600E mutation, extrathyroidal extension (ETE), central lymph node metastasis (CLNM), and advanced disease stage (all p < 0.05). The BRAF V600E mutation was observed in 80.7% (1189/1474) of patients. Stratified analysis by tumor size showed that BRAF V600E mutation independently predicted CLT and advanced tumor-node-metastasis (TNM) stage in papillary thyroid microcarcinoma (PTMC); CLT, ETE, and CLNM in tumors 1-2 cm; CLT, ETE, CLNM, and lateral lymph node metastasis (LLNM) in tumors 2-4 cm; and CLT, ETE, vascular invasion, CLNM, and LLNM in tumors >4 cm (all p < 0.05). Notably, PTC patients without CLT but harboring BRAF V600E mutation showed a combined association with advanced TNM stage and aggressive features. The presence of CLT appears to exert a protective effect in PTC. However, the prognostic significance of BRAF V600E mutation varies with tumor size. While CLT-related inflammatory microenvironment may counteract tumor progression in small cancers, it seems insufficient to mitigate the aggressive behavior driven by BRAF V600E mutation in larger tumors.

BackgroundCentral lymph node metastasis (CLNM) significantly elevates the risk of postoperative recurrence and contributes to ongoing debates regarding the necessity of prophylactic dissection in clinically node-negative papillary thyroid microcarcinoma (PTMC). Therefore, accurate preoperative prediction of occult CLNM is crucial for tailoring individualized treatment strategies.Patients and methodsThis retrospective study included 461 patients with PTMC from two hospitals who underwent preoperative ultrasound. A dual-channel deep learning (DL) model was developed by combining longitudinal and transverse ultrasound images. The model’s performance was compared with single-direction DL models and a clinical model using machine learning classifiers. Performance was evaluated using the area under the receiver operating characteristic curve (AUC) and calibration curves.ResultsThe dual-channel DL model outperformed the single-direction models, with AUC values of 0.765 in the training set and 0.726 in the external test set. The combined model, which integrated DL features and clinical indicators, achieved the highest AUC of 0.900 in the training set and 0.873 in the external test set, surpassing both the deep learning model using fused DL model (DL_F) and clinical models.ConclusionsThe dual-channel DL model demonstrated superior performance in predicting occult CLNM in PTMC patients. When combined with clinical features, it offers a robust tool for personalized risk stratification and treatment decision-making, providing a non-invasive method for predicting occult CLNM and supporting individualized treatment strategies.

Hypoparathyroidism and hypocalcemia are common complications following total thyroidectomy (TT). This study aimed to evaluate the risk of post-total thyroidectomy transient hypoparathyroidism and hypocalcemia through a large single-center retrospective analysis. In this retrospective study, consecutive patients underwent total thyroidectomy from May 2021 to September 2022 were included. Postoperative parathyroid hormone (PTH) level and serum calcium levels were evaluated within 24h. Univariate and multivariate analysis were performed for assessing risk factors for developing transient hypoparathyroidism and hypocalcemia after total thyroidectomy. A total of 1065 patients undergoing total thyroidectomy who met the inclusion criteria were enrolled in this study. Among the patients, 460 patients (43.2%) developed hypoparathyroidism after surgery, and a total 325 patients (30.5%) developed hypocalcemia. After multivariate analysis, the independent risk factors related to hypoparathyroidism are female (OR = 1.65, p < 0.001), inadvertent parathyroidectomy (OR = 2.26, p = 0.004), non-papillary thyroid microcarcinoma (OR = 1.55, p = 0.003) and capsule invasion (OR = 1.39, p = 0.034). Meanwhile, the independent risk factors related to hypocalcemia are female (OR = 1.94, p < 0.001) and inadvertent parathyroidectomy (OR = 2.01, p = 0.011). Transient hypoparathyroidism and hypocalcemia are relatively common complications following total thyroidectomy. Female, inadvertent parathyroid gland excision, papillary thyroid microcarcinoma, and capsular invasion were identified as independent risk factors for hypoparathyroidism and hypocalcemia.

Synchronous muscle and bone metastases in thyroid cancer

Development and validation of a risk nomogram for predicting central lymph node metastasis in papillary thyroid microcarcinoma.

Thermal Ablation Versus Thyroid Lobectomy for Subcapsular Papillary Thyroid Microcarcinoma: A Multicenter Retrospective Study.

The necessity of total thyroidectomy for Graves' disease (GD) remains a subject of debate due to lifelong thyroxine replacement therapy. However, total thyroidectomy is a definitive treatment and allows for the detection of incidental thyroid cancer (ITC), which may necessitate further surgical intervention if not initially treated. This study aimed to investigate the prevalence, clinicopathological characteristics, and risk factors associated with ITC in GD patients undergoing total thyroidectomy. We conducted a retrospective cohort study of 86 GD patients who underwent total thyroidectomy from January 2016 to December 2022. Clinical and pathological characteristics were analyzed to determine potential risk factors associated with ITC. The incidence of ITC was 15.1% (13/86), predominantly papillary thyroid microcarcinoma (PTMC) at 9.3% (8/86). Patients with ITC were significantly older (mean age 45.2years vs. 36years, p = 0.017) and more frequently presented thyroid nodules on ultrasound (84.6% vs. 45.2%, p = 0.014). Multivariate analysis identified thyroid volume as a significant protective factor, with each 1mL increase reducing ITC risk by approximately 6% (p = 0.009). Older age, smaller thyroid volume, and the presence of thyroid nodules on ultrasound were significantly associated with increased ITC risk. A larger thyroid volume may be associated with a lower risk of ITC. Careful preoperative evaluation, including assessment of thyroid nodules on ultrasound, is advised in older patients and those with smaller glands. Surgical decisions should be guided by individual risk factors and shared decision-making.

The value of a multimodal ultrasound radiomics-based nomogram in predicting central lymph node metastasis of papillary thyroid microcarcinoma.