Papiller tiroid mikrokarsinomunun santral lenf nodu metastazını öngörmede moleküler belirteçler ve klinikopatolojik özelliklerin rolü

Background: Despite the favorable prognosis of papillary thyroid microcarcinoma (PTMC), the frequent occurrence (up to 60%) of central lymph node metastasis (CLNM) poses a significant challenge, influencing recurrence and survival. The limited accuracy of preoperative neck ultrasonography in detecting CLNM necessitates exploring a combination of radiologic, histopathologic, and clinical factors for effective prediction of CLNM. This study aims to evaluate the predictive value of molecular markers and clinicopathological features for CLNM in PTMC patients. Methods: Between February 2019 and December 2023, patients who underwent thyroidectomy operations at Koç University Hospital and American Hospital were included in this study. From this group, 145 patients with tumor sizes ≤10 mm (PTMC) were included in the study. Those without prophylactic or therapeutic central neck dissection, and with <3 excised lymph nodes were excluded from the study. Patients were divided into two study groups based on CLNM. Patient demographics and clinicopathological features, BRAFV600E mutation, desmoplasia and Masson trichrome staining were evaluated. Both univariate and multivariate logistic regression analyses were performed. Results: Among the 65 participants, 35 (53.8%) exhibited CLNM. Larger tumor sizes, lymphovascular invasion, aggressive subtype presence, BRAFV600E mutation positivity, higher extent and intensity scores of desmoplasia and trichrome staining were significant predictors of lymph node metastasis on univariate analyses (p<0.001). In order to predict the presence of CLNM, multivariate logistic analyses were performed. It was established that diffuse desmoplasia and trichrome extent increased the probability of lymph node metastasis by 13.6 and 9.8, respectively. Conclusion: The findings of this study revealed significant associations between increased desmoplasia and trichrome staining scores and the probability of lymph node metastasis. However, further prospective studies with larger cohorts and comprehensive molecular analysis to validate these preliminary findings. Keywords: Desmoplasia; Lymph node metastasis; Papillary thyroid microcarcinoma