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Sang-Hyeon Ju Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea

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Yong Bae Ji Department of Otolaryngology–Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea

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Minchul Song Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea

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Joung Youl Lim Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea

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Da Beom Heo Department of Otorhinolaryngology–Head and Neck Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea

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Min-Gyu Kim Department of Otorhinolaryngology–Head and Neck Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea

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Jae Won Chang Department of Otorhinolaryngology–Head and Neck Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea
Department of Otorhinolaryngology–Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Republic of Korea

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Ho-Ryun Won Department of Otorhinolaryngology–Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Republic of Korea
Department of Otorhinolaryngology–Head and Neck Surgery, Chungnam National University Sejong Hospital, Sejong, Republic of Korea

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Yea Eun Kang Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea

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Eu Jeong Ku Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea

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Mijin Kim Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea

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Eun Kyung Lee Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Goyang-si, Republic of Korea

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June Young Choi Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea

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Hyeong Won Yu Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea

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Young Joo Park Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea

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Jun-Ho Choe Division of Endocrine Surgery, Department of Surgery, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea

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Bon Seok Koo Department of Otorhinolaryngology–Head and Neck Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea
Department of Otorhinolaryngology–Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Republic of Korea

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the MASTER study group †
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the MASTER study group

Objective

Active surveillance (AS) is generally accepted as an alternative to immediate surgery for papillary thyroid carcinoma (PTC) measuring ≤1.0 cm (cT1a) without risk factors. This study investigated the clinicopathologic characteristics of PTCs measuring ≤2.0 cm without cervical lymph node metastasis (cT1N0) by tumor size group to assess the feasibility of AS for PTCs between 1.0 cm and 1.5 cm (cT1b≤1.5).

Design

This study enrolled clinically T1N0 patients with preoperative ultrasonography information (n= 935) from a cohort of 1259 patients who underwent lobectomy and were finally diagnosed with PTC from June 2020 to March 2022.

Results

The cT1b≤1.5 group (n = 171; 18.3 %) exhibited more lymphatic invasion and occult central lymph node (LN) metastasis with a higher metastatic LN ratio than the cT1a group (n = 719; 76.9 %). However, among patients aged 55 years or older, there were no significant differences in occult central LN metastasis and metastatic LN ratio between the cT1a, cT1b≤1.5, and cT1b>1.5 groups. Multivariate regression analyses revealed that occult central LN metastasis was associated with age, sex, tumor size, extrathyroidal extension, and lymphatic invasion in patients under 55, while in those aged 55 or older, it was associated only with age and lymphatic invasion.

Conclusion

For PTC patients aged 55 years or older with cT1b≤1.5, AS could be a viable option due to the absence of a significant relationship between tumor size and occult central LN.

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