2108 Cases of Thyroid Cancer: Cervical Lymph Node Dissection or Not

2108 Cases of Thyroid Cancer: Cervical Lymph Node Dissection or Not | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article 2108 Cases of Thyroid Cancer: Cervical Lymph Node Dissection or Not Lin Han, Zhen Wu, Wenlei Li, Yingxue Li, Jinglin Ma, Xinxin Wu, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-133510/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Based thyroid cancer data from patients treated in Liaocheng People’s Hospital from 2015 to 2018, with Chinese national and regional characteristics, in this study we addressed the controversy of which initial thyroid surgical mode, lobectomy or total thyroidectomy, is most effective. Clinical and pathological data from 2108 patients with thyroid cancer, who were initially diagnosed and treated surgically, were collected from the Department of Thyroid Surgery. The overall metastasis rate of all patients was 57.23%.With the increase of tumor diameter, the metastasis of cervical lymph nodes ranged from 22.54–73.33%, which showed positive correlation.49.32% of patients had lymph node metastasis in the lateral cervical region.When the diameter of the tumor reached T1c level, the metastasis of the cervical lymph nodes was 56.91%, and the number of metastatic cases above T1c level accounted for 69.96% of the total metastatic cases. It is recommended that initial treatment should comprise at least total thyroidectomy + central lymph node dissection in China, to avoid the risks associated with secondary surgery and effects on patient quality of life.When the tumor diameter exceeds 1 cm, the risk of cervical lymph node metastasis is high, we recommended the lateral lymph node dissection. Health Economics & Outcomes Research Cancer Biology Oncology Scientific Communication thyroid cancer metastasis surgery real world initial treatment Figures Figure 1 Figure 2 Introduction In the past 30 years, the incidence of thyroid cancer has been increasing annually worldwide, with the incidence in China also rising. In 2012, the number of new cases and deaths from thyroid cancer in China accounted for 15.6% and 13.8%, respectively, of the global total. It is estimated that by 2019, thyroid cancer will become the third most common malignancy in women in the United States, leading to medical expenditure of approximately $ 19–21 billion, representing a heavy economic burden on both society and individuals(La Vecchia C et al.2015). Differentiated thyroid carcinoma accounts for 80–90% of thyroid cancer incidence and the most common metastasis is to the cervical lymph nodes, which seriously influences patient prognosis. Therefore, effective and appropriate surgical treatment of differentiated thyroid carcinoma is of great clinical significance. Total thyroidectomy and lobectomy remain the main primary surgical interventions for thyroid carcinoma. To date, there has been no large sample randomized controlled clinical trial to compare these two methods, hence their relative efficacy remains controversial and comparative studies have relied mainly on retrospective analyses(Bilimoria K et al.2007). This indicates that although papillary thyroid carcinoma(PTC) progress is slow, the ability and tendency to metastasize to lymph nodes and even distant organs are consistent with other malignancies. In generally, it is unscientific to classify malignant tumors based on tumor size. The invasiveness and distant metastatic ability of tumors are derived from the evolution of the tumor genome(Ito Y et al.2018,Vigneri R et al.2015).There are still different opinions on whether to perform preventive lateral neck lymph node dissection. The focus of debate is on the following aspects: Preventive lateral neck lymph node dissection needs to expand neck incision and affect appearance; Lateral neck lymph node dissection can cause shoulder syndrome, which seriously affects the patient's quality of life; Differentiated thyroid cancer is slow to develop, as long as it is closely followed by diagnosis, allowing treatment when suspicious lymph nodes are found(Wu X et al.2019,Mendelsohn AH et al.2010). We collected clinical and pathological data from 2108 patients undergoing treatment at the Department of Thyroid Surgery, Liaocheng People’s Hospital, and analyzed their responses to current treatment approaches. Using accurate clinical data, we aimed to settle the controversy about appropriate treatments for thyroid cancer and determine the most appropriate initial surgical intervention for patients in China with this condition. Methods This study was a retrospective analysis of a total of 2108 cases of PTC treated and undergoing surgery from January 1 to December 31, 2018 in the Department of Thyroid Surgery, Liaocheng People’s Hospital, Clinical Hospital of Shandong First Medical University, China. All patients underwent fine needle aspiration before surgery, and had pathological diagnoses of papillary carcinoma or suspected papillary carcinoma. Surgical procedures were as follows: 1001 cases were treated with total thyroidectomy + central node dissection. Total thyroidectomy + central lymph node dissection + lateral neck node dissection were performed in 1107 cases. For patients < 18 years old, informed consent was obtained from both parents. Surgical methods were based on the guidelines of Chinese Thyroid Cancer (CTA), following the experience of clinical professors. We confirm that all methods were performed in accordance with the relevant guidelines. Written informed consent for participation in this study was obtained from each patient after full explanation of the purpose and nature of all procedures used. All patients agreed to receive total thyroidectomy. The study was conducted in accordance with the Declaration of Helsinki. The ethical approval number is 2016071. Before surgery, patients and their families were fully informed and discussed the implications. Pathological data were obtained from the Department of Pathology, Liaocheng People’s Hospital, Clinical Hospital of Shandong First Medical University, and were based on post-operative analysis of paraffin-embedded tumor samples. Pathological data were stored in a unified database, and comprise standard information, including preoperative fine needle biopsy cytology pathology, intraoperative rapid frozen pathology, and postoperative routine paraffin pathology. Information on all patients was systematically coded in a single computer file. Data from this system were exported for statistical analyses. Results All patients were treated directly after discovery of the lesion, without any observation period. Cases included 416 males and 1692 females, and were 13–79 years old, with 285 cases aged ≤ 35 years (Table 1 ). Table 1 The age and gender of patients age male female total ≤ 20 8 26 34 ≤ 30 37 60 97 ≤ 40 112 454 566 ≤ 50 108 511 619 ≤ 60 87 402 489 ≤ 70 49 204 253 > 71 15 35 50 The pathological subtypes present among the 552 cases of PTC were classical (n = 537), follicular variant (n = 12), tall cell variant (n = 2), and solid variant (n = 1). The main diagnostic features of the classical variant (Fig. 1 A) are papillary structures and nuclear features, including enlarged nuclei, increased nuclear/cytoplasmic (N/C) ratio, nuclear grooves, and nuclear pseudo-inclusions. The follicular variant of PTC also has nuclear features, but not papillary structures (Fig. 1 B), while the tall cell variant is composed of epithelial cells that have a height-to-width ratio exceeding 3:1, with abundant eosinophilic cytoplasm (Fig. 1 C). The solid variant of PTC is characterized by solid nests of epithelial cells with well-defined borders, but which fail to form follicles and lack colloid storage (Fig. 1 D). Both classical type and the follicular variant PTC are associated with similar prognosis, and together these accounted for 99.5% of our cases. The tall cell variant and the solid variant are associated with more aggressive tumor behavior compared with classical PTC. There were 2,108 cases of thyroid papillary carcinoma, 1,001 cases of total thyroidectomy + central lymph node dissection, and 1107 cases of total thyroid dissection + central lymph node dissection + cervical lymph node dissection. The average metastasis rate was 57.23%. The proportion of metastasis was positively correlated with tumor diameter, from 36.22–77.22%. However, T3 patients may have a low rate of lymph node clearance due to irregular surgical treatment or intraoperative surgery strategies, resulting in deviations in data(Table 2 , 3 ). The proportion of thyroid micropapillary carcinoma was 55.12%, and the lymph node metastasis rate was 48.97%(Table 4 ). Table 2 Thyroid cancer diameter and metastasis Item Case Ratio Metastasis Ratio T1a 442 20.97% 160 36.20% T1b 720 34.16% 409 56.81% T1c 604 28.65% 428 70.86% T2 316 14.99% 244 77.22% T3 26 1.23% 17 65.38% Collection 2108 1258 57.23% Table 3 The diameter and metastasis of thyroidectomy + central node dissection Item Case Ratio Metastasis Ratio T1a 300 29.97% 99 33.00% T1b 370 36.96% 170 45.95% T1c 235 23.48% 119 50.64% T2 85 8.49% 41 48.24% T3 11 1.10% 5 45.45% Collection 1001 434 43.36% Table 4 The proportion and clinical characteristics of patients with papillary thyroid microcarcinoma. cases proportion metastasis proportion central lymph node proportion lateral neck lymph node proportion 1162 55.12% 569 48.97% 405 34.85% 164 14.11% There were 773 bilateral tumors, accounting for 35.17%, and the transfer rate was 65.27%. There were 547 cases of multiple tumors, accounting for 24.89%, the transfer rate was 72.21%, and 343 cases of bilateral combined multiple tumors, accounting for 15.61%, and the transfer rate was 74.05%.There were 483 cases of tumor broke through the membrane, accounting for 22.91%, and the metastasis rate was 67.08%.(Table 5 ) When the tumor is combined with bilateral, multiple, and breakthrough membranes, the metastasis rate is higher than the average transfer rate, and the analysis has statistical significance. Table 5 The surgery and high-risk factors of thyroid cancer. Item Case Ratio Metastasis Ratio Bilateral 773 35.17% 508 65.27% Multiple 547 24.89% 395 72.21% Both 343 15.61% 254 74.05% Capsule invasion 483 22.91% 324 67.08% In 1001 cases, only central lymph node clearance was performed, accounting for 47.48%, and the transfer rate was 41.86%. In 1107 patients, cervical lymph nodes were increased, accounting for 52.51%, and the transfer rate was 74.44%(Table 6 ). With the increase in tumor diameter, the overall metastasis rate increased from 42.96–87.88%, of which patients with T3 may have a relationship with surgical treatment or surgical strategy during surgery, and the lymph node metastasis rate(80%) is lower than that of T2(87.88%), there's a discrepancy in the data(Table 7 ). The metastasis rate of cervical lymph nodes was also positively correlated with tumor diameter, from 22.54–73.33%. Neck lateral metastasis occurred in 546 of all tumors, accounting for 49.32%(Table 7 ). Table 6 The metastasis of thyroid cancer. Item Case Ratio Metastasis Ratio Total thyroidectomy central lymph node dissection 1001 47.48% 419 41.86% Total thyroidectomy central lymph node dissection lateral neck node dissection 1107 52.51% 824 74.44% Table 7 The metastasis of lateral neck node. Case Metastasis Cervical T1a 142 61 32 12.83% 42.96% 22.54% T1b 350 239 132 31.62% 68.29% 37.71% T1c 369 309 210 33.33% 83.74% 56.91% T2 231 203 161 20.87% 87.88% 69.69% T3 15 12 11 1.35% 80% 73.33% Collection 1107 824 546 74.44% 49.32% 25.56% of patients had negative lymph nodes in the central and neck regions, and 25.11% of patients had only central lymph node metastasis, that is, 50.67% of patients had cervical lymph nodes that were safe. The proportion of patients with metastasis in both the central area and the neck area was 42.55%, of which 39.49% were from T1c patients. In all patients with positive lymph nodes in the central area, 62.88% of the patients had cervical metastasis. Only 6.78% of patients had jump metastasis, that is, the central lymph nodes were negative, and cervical lymph node metastasis occurred, of which T1c patients accounted for 30.67%, T1c and above patients accounted for 78.55%(Table 8 ). Table 8 The metastasis of central and lateral neck node. cervical Cases T1a T1b T1c T2 T3 0–0 283 81 111 61 28 2 25.56% 28.62% 39.22% 21.55% 9.89% 0.71% 0–1 75 11 18 23 20 3 6.78% 14.67% 24% 30.67% 26.67% 4% 1 − 0 278 29 107 98 42 2 25.11% 10.43% 38.49% 35.25% 15.11% 0.72% 1–1 471 21 114 186 141 8 42.55% 4.46% 24.2% 39.49% 29.94% 1.69% Of the patients with T1a, 57.04% did not have metastasis. In T1b, there was no metastasis in 31.71% of lymph nodes, 30.57% had only central lymph node metastasis, and 32.57% had metastasis in Central and neck regions. In T1c patients, 50.41% of patients had metastasis. In T2 patients, the metastasis rate was 61.04%, and in T3 patients, it was as high as 53.3%(Table 9 ). Table 9 The diameter and metastasis of cervical lymph node. cervical Cases 0–0 0–1 1 − 0 1–1 T1a 142 81 11 29 21 57.04% 7.75% 20.42% 14.79% T1b 350 111 18 107 114 31.71% 5.14% 30.57% 32.57% T1c 369 61 23 98 186 16.53% 6.23% 26.56% 50.41% T2 231 28 20 42 141 12.12% 8.66% 18.18% 61.04% T3 15 2 3 2 8 13.33% 20% 13.33% 53.33% In addition, we enumerated the number of cases of surgery for thyroid cancer at our hospital from 2009–2018 and the results demonstrate that the number of cases generally rose annually by 4.72–18.16% (Fig. 2 ). Discussion According to the results of the SEER database of the National Cancer Center of the United States, the incidence of both PTC < 1.0 cm and thyroid cancers 1.0–4.0 cm increased from 1980 to 2010, especially among highly educated groups(Alwithenani R et al.2019). Statistical data from the United States and South Korea show an increase in the incidence of thyroid cancer(Jingqiang Z et al.2016). Further, the results of surveys in Denmark, Finland, Israel, Japan, Spain, and Switzerland also demonstrate increases in thyroid cancer incidence, which is mainly PTC, with significant sex differences in the relative extent of the rise. This phenomenon cannot be fully explained by improvements in the sensitivity of testing methods, nor increased awareness among doctors and patients of screening(McDow AD et al.2019). Scholars from other countries have actively researched the risk factors associated with thyroid cancer, and found that autoimmune disorders, ionizing radiation, iodine intake, estrogen, environmental endocrine disruptors, negative psychosocial factors, and heredity may contribute to increases in thyroid cancer incidence(Huang T.2016,Dettmer MS et al.2019). From 1984 to 2010, the incidence of differentiated thyroid carcinoma in the United States increased, with tumors of diameter ≤ 0.5 rising by 5.09%, while those of 0.5–0.99 cm in diameter increased by 8.45%, average diameter tumors (1.0–1.99 cm) by 3.42%, and large tumors ≥ 2.0 cm by 2.96%. These data suggest that most PTMCs will develop into tumors with diameter > 1 cm, but over varying periods of time. In particular, the possibility of dedifferentiation increases with prolonged tumor-bearing time and patient age(Dong F et al.2016,Li N et al.2013). It is generally recognized that, over time, the degree of malignancy and dedifferentiation of PTC tumors increases; however, when the level of malignancy changes, what causes changes in the tumor genome has not been fully or satisfactorily explained(Ahn HS et al.2014). As available therapies for thyroid cancer are effective, there is little drive for early diagnosis and surgical treatment, which is counterintuitive and violates the basic principles of pursuing early detection, with the aim of early diagnosis and treatment of malignant tumors. In addition, the psychological pressure on patients of the uncertainty of following up while waiting for the diagnosis of malignancies to change before taking action, is undoubtedly considerable. Cancer does not have specific Chinese characteristics. In 2014, the Memorial Sloan-Kettering Cancer Center in the United States launched a “wait-and-see” program for patients with thyroid cancer(Pellegriti G et al.2013). Patients diagnosed with microcarcinoma of the thyroid could choose not to have it removed for a while, but rather to have it checked regularly; however, the vast majority of patients with PTMC did not hesitate to choose surgical treatment. Further, some patients who chose the observation option eventually asked for surgery, and doctors feared being sued for missing the optimal treatment time. Early treatment is not only effective, it is also associated with reduced risk and fewer complications(Choi WR et al.2019). Once lymphatic metastases, or distant lung and bone metastases, occur, the cost of medical care often increases considerably, which can even endanger the life of the patient. According to our clinical and pathological data, as the diameter of the mass increases, the proportion of lymph node metastasis increases, from 44.68–77.53%. The proportion of micropapillary carcinoma ≤ 1 was 47.10%, and the rate of lymph node metastasis was 46.92%, which did not mean that the risk of microcarcinoma was low. Lymph node metastasis is also an indicator of malignancy. With the passage of time, the tumor size, the proportion and the number of lymph node metastasis will further increase, leading to the disease progression, the difficulty and risk of surgery, and the risk of recurrence and metastasis gradually increased. When the mass rises above 2 cm, the lymph node metastasis ratio rises to 77.53%, indicating that thyroid papillary carcinoma is progressing, the malignant degree and the disdifferentiation increases, although there is no way to evaluate and predict it. Compared with the National Comprehensive Cancer Network (NCCN) and the American Thyroid Association (ATA) guidelines for the diagnosis and treatment of differentiated thyroid cancer, Chinese guidelines for patients undergoing thyroid surgery to remove all indications do not include any specific age-based requirements. The NCCN guidelines recommend that patients with PTC aged 45 years should undergo total thyroidectomy. While the ATA guidelines recommend total thyroidectomy for all patients with PTC with tumor diameters > 1 cm, unlike Chinese guidelines. Further, total thyroidectomy is also recommended for all patients with thyroid nodules in the contralateral gland and for patients with PTC with tumor diameters 1.0–1.5 cm, aged > 45 years. In addition, Chinese guidelines indicate that all patients with differentiated thyroid cancer should receive central region lymph node dissection, as this provides effective protection from recurrent laryngeal nerve and parathyroid gland involvement. The NCCN and ATA guidelines recommend no dissection of the central lymph node without involvement, except for abnormal palpation or clear metastasis diagnosed by puncture biopsy. Total thyroidectomy can have advantages for patients, including: 1) single treatment of multiple lesions, particularly bilateral cancer lesions; 2) facilitates postoperative monitoring of tumor recurrence and metastasis; 3) beneficial for postoperative I 131 treatment; 4) reduces the recurrence rate of tumors and the probability of reoperation, which avoids increasing the incidence of serious complications due to reoperation; 5) accurate assessment of postoperative staging and risk stratification of patients; 6) prevention of recurrence of thyroid cancer from development into poorly differentiated thyroid cancer. The bilateral tumor metastasis rate is 65.27%, the recurrent cancer metastasis rate is 72.21%, the tumor breakthrough membrane metastasis rate is 67.08%, and the metastasis rate is higher than the average metastasis rate. The analysis is statistically significant. When combined with high risk factors, such as bilateral lesions, multiple lesions and tumor rupture membranes, the lymph node metastasis rate will increase significantly(Ruggiero R et al.2019). It is recommended that we conduct more comprehensive preoperative clinical assessments to facilitate us to obtain more comprehensive patient disease information. Thyroidectomy and central lymph node dissection may be more reasonable, thorough, and safe procedures for clinicians to consider.At present, some preoperative examinations used in clinical practice cannot reveal suspected cancer lesions in the contralateral glandular lobe. Total thyroidectomy completely removes any such lesions and glands with potential lesions, thereby avoiding the risk of undetected cancer lesions, reducing the recurrence rate, and improving patient prognosis(Zheng X et al.2019,Chen Y et al.2014). In patients with PTC, thyroid globulin levels can be assessed postoperatively to determine whether there is residual tumor or recurrence. For patients with all thyroid tissue removed, there should be no thyroid globulin present in the body; hence, if thyroid globulin is detected in the serum, it generally indicates that some lesion remains or has relapsed, which is also an important prognostic indicator. Total thyroidectomy increases the incidence of recurrent laryngeal nerve and parathyroid gland injury, and any complications will have a serious impact on the mental health and quality of life of patients postoperatively. Therefore, surgeons must receive strict guidance and training to reduce or avoid surgical complications. Doctors undergoing training who may conduct lateral + isthmus + contralateral subtotal thyroidectomy should ensure that very small amounts of non-tumor thyroid tissue is left on the contralateral glandular lobe only to avoid recurrent disease of the laryngeal nerve and around the parathyroid gland. Simultaneously, in combination with the application of nano-carbon and nerve monitoring during surgery, to avoid bilateral recurrent laryngeal nerve or parathyroid gland damage, residual thyroid tissue can be dealt with using radioactive I 131 therapy following surgery. The cervical lymph node metastasis rate was also positively correlated with the tumor diameter. In all tumors, 49.32% of patients had cervical regional metastasis, of which 69.40% were T1c and above tumor patients. Of the patients with T1c, 76.97% had central lymph node metastasis, of which 65.50% had cervical lymph node metastasis at the same time. Although only 6.78% of patients had jump metastasis, T1c patients accounted for 30.67%, and T1c and above patients accounted for 78.55%. It is suggested that when we treat T1c patients, we should fully evaluate the preoperative evaluation. As far as possible, the original lesion and metastatic lesion should be cleaned together during the initial operation to avoid reoperation. The surgical method can consider cervical lymph node clearance.Thyroid cancer has a good prognosis and long survival. Therefore, we should try our best to protect the function of the tumor while improving the quality of life. It is recommended to keep the sternocleidomastoid, the internal jugular vein and the accessory nerve, and try to keep the cervical plexus neurocutaneous branch. At present, the modified radical neck dissection (MRND) is the most commonly used procedure for both thorough surgery and preservation of the body function. Lymph node metastasis of thyroid papillary carcinoma is common to the ipsilateral side, and it is transferred along the lymphatic drainage path. The lymphatic metastasis is usually first to the paratracheal lymph node, and then drained to the jugular vein lymph node (levelⅡ-Ⅳ) and the posterior cervical lymph nodes (levelⅤ), or down the trachea to the upper mediastinum. The most common site in the 6th district, followed by the neck Ⅲ,Ⅳ,Ⅱ,Ⅴlevel, and the lymph node metastasis of papillary thyroid carcinoma is mainly metastasis. At present, surgical treatment of cervical lymph node metastasis of papillary thyroid carcinoma is recommended for the treatment of cervical lymph node dissection. Prophylactic dissection is not recommended. The occult metastasis of cervical lymph nodes does not reduce the survival rate of patients, so prophylactic cervical lymph node dissection is not recommended in patients with cN0. For patients with cN1, lymph node metastasis is an independent risk factor for the survival of patients with > 45-year-old papillary thyroid carcinoma(Hodax JK et al.2019,Morris LG et al.2016). levelⅡ-Ⅳis the main area of thyroid lymphatic drainage, and levelⅢ,Ⅳis the most common lymph node metastasis. Domestic experts agree that levelⅡa,Ⅲ,Ⅳ,Ⅴb is the standard range of cervical lymph node dissection(Yan L et al.2019). It is recommended that patients with cervical lymph node metastasis confirmed by preoperative evaluation or intraoperative frozen pathological examination receive cervical lymph node dissection, but preventive cervical lymph node dissection is not recommended(Kaliszewski K et al.2019).Reoperation will increase the complications of surgery, and it will lead to recurrence of disease after thyroid cancer surgery, and even affect survival. At the same time, as the number of operations increases, the degree of tumor dedifferentiation will increase, and the difficulty and risk of surgery will increase. It is impossible to completely remove the surgery again, so that the patient who can be cured can lose the opportunity to cure(Eanaola NF et al.2002,Gimm O et al.2002). Thyroidectomy can lead to complications, primarily parathyroid injury (3–5%) and recurrent laryngeal nerve injury (1–5%). It is accepted that patients who undergo total or partial thyroidectomy must use thyroxine replacement, or even suppression, therapy for the rest of their lives(Haugen BR et al.2016,Polistena A et al.2017). Data from our hospital related to hypocalcemia, hoarseness, and sensory dysfunction of the shoulder after thyroid surgery currently undergoing statistical analysis and will be presented in future reports. The pathological characteristics of PTC mean that analysis of the influence of surgical approach on survival and prognosis will be a long-term project, and we will continue to analyze follow-up data for these patients. Only a small number of patients were found to have BRAF gene mutations in our study, as there is no comprehensive promotion of genetic testing in our hospital, hence not all patients were evaluated. According to the CTA, endocrine inhibition therapy is essential, regardless of surgical approach. Hence, long-term endocrine suppression therapy was required for all patients with PTC, including those who underwent lobectomy + central lymph node dissection. Radioactive I 131 therapy is also an important part of comprehensive treatment of thyroid cancer(Yang T et al.2019,Conzo G et al.2014). All patients with lymph node metastasis, whether in the central or cervical region, were treated with I 131 administered at doses of 80–130 mCi, according to risk stratification assessment, with additional rounds of treatment if needed, based on the results of follow-up observation. The method of treatment of thyroid cancer is influenced not only by surgeons, but also by nuclear medicine, imaging, and other clinicians, and even by health insurance companies. Careful preoperative staging and risk stratification of thyroid carcinoma results in better outcomes for patients with thyroid carcinoma. This is because such an approach facilitates more accurate surgery, and individualized treatment, as well as allowing collection of data on national trends in this disease. The authors consider that surgeons should fully embrace the principles of tumor prevention and treatment, and be mindful that thyroid cancer is a malignant tumor; hence, the scope of treatment should not be reduced unnecessarily, to avoid the need for reoperation several years later. Therefore, it is necessary to assess patients, according to current scientific knowledge, to make a comprehensive judgment of the safety of surgery, the willingness of the patient, and medical resources available, together with the national considerations and regional factors in China, and the degree of acceptance of the operation and possible secondary surgery by the patient. Together, this information can inform implementation of rational diagnosis and treatment plans. Abbreviations PTC:papillary thyroid carcinoma PTMC:papillary thyroid microcarcinoma CTA:Chinese Thyroid Cancer NCCN:National Comprehensive Cancer Network ATA:American Thyroid Association MRND:modified radical neck dissection Declarations The data from our department inform several important points. 1. The incidence of thyroid cancer cases in our hospital generally rose annually during 2009–2018 from a minimum of 247 to a maximum of 600 (increase rates from 4.72%–18.16%); hence, thyroid cancer has become a common malignancy threatening the physical and mental health of patients and representing a dark psychological shadow and economic burden on both individuals and society. 2. PTC, even PTMC, has a high rate of local metastasis (57.23% and 48.97%, respectively) as, although it is an inert tumor after recovery, high invasiveness can occur on evolution of the tumor genome, indicating that it cannot be considered to exhibit a low degree of malignancy, suggesting that we should give more active and thorough treatment. 3. When there were complications, such as bilateral lesions, multiple lesions,and tumor breakthrough membranes, tumors were highly aggressive, suggesting that priority should be given to total central thyroidectomy lymph node dissection. Postoperative complications and long-term follow-up data will be reported in the future. 4. There is no need to prevent cervical lymph node clearance, but when the mass reaches T1c, the risk of central area, neck side area and jump type metastasis is obviously high. It is recommended to give cervical side lymph node clearance so that it is more complete and safer. Authors’ contributions All authors contributed equally, there is no sequence. Yongkun Wang and Zhen Wu were responsible for the study design.Wenlei Li an Lin Han were responsible for data interpretation. Yingxue Li and Jinglin Ma were responsible for writing the manuscript. Wenjuan Wen and Xinxin Wu were responsible for conducting the literature search. Yumin Yao and Rui Li were responsible for data analyses. All authors read and approved the final manuscript. Acknowledgments We thank Shandong First Medical University and Liaocheng People’s Hospital for supporting this study, and also the pathology and thyroid surgery staff for their support and assistance in conducting this study. We thank everyone involved in this study for their hard work. Competing Interests The authors declare that they have no conflicts of interest. Availability of data and material We confirm that we will share the data underlying the findings reported in this manuscripts and allow researchers to verify the results presented, replicate the analysis, and conduct secondary analyses. All medical records are legal and reasonable. The study was approved and supervised by the ethics committee of Liaocheng People’s Hospital, affiliated to Shandong First Medical University. This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sectors. References Ahn HS, Kim HJ, Welch HG.2014. Korea’s thyroid-cancer epidemic-screening and overdiagnosis. N Engl J Med . 2014;371(19):1765–1767. Alwithenani R , DeBrabandere S , Rachinsky I .2019. Performance of the American Thyroid Association risk classification in a single center cohort of pediatric patients with differentiated thyroid cancer: A retrospective study. J Thyroid Res . 2019;2019:5390316. Bilimoria K, Bentrem DJ, Ko CY.2007. 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Surgery for papillary thyroid carcinoma: is lobectomy enough? Arch Otolaryngol Head Neck Surg . 2010;136(1):1055–1061. McDow AD , Pitt SC .2019. Extent of surgery for low-risk differentiated thyroid cancer. Surg Clin North Am . 2019;99(4):599–610. Morris LG, Wong RJ, Tuttle RM.2016. Ethical considerations when counseling patients with thyroid cancer about surgery vs observation. JAMA Otolaryngol Head Neck Surg . 2016;142(4):406–407. Pellegriti G, Frasca F, Regalbuto C.2013. Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemiol . 2013;2013:965212. Polistena A, Sanguinetti A, Patrone R.2017. Unintentional recurrent laryngeal nerve injuries following thyroidectomy: Is it the surgeon who pays the bill? Int J Surg . 2017;41(Suppl 1):S55–S59. Ruggiero R , Pirozzi R , Gualtieri G .2019. Overview on surgical management of papillary thyroid microcarcinoma. G Chir . 2019;40(2):81–87. Vigneri R, Malandrino P, Vigneri P.2015. The changing epidemiology of thyroid cancer: why is incidence increasing? Curr Opin Oncol. 2015;27(1):1–7. Wu X , Li B , Zheng C , He X .2019. Predicting factors of lateral neck lymph node metastases in patients with papillary thyroid microcarcinoma. Medicine . 2019;98(27):e16386. Yan L , Blanco J , Reddy V .2019. Clinicopathological features of papillary thyroid microcarcinoma with a diameter less than or equal to 5 mm. Am J Otolaryngol . 2019;40(4):560–563. Yang T , Zheng SY , Jiao J .2019. Radioiodine remnant ablation in papillary thyroid microcarcinoma: a meta-analysis. Nucl Med Commun . 2019;40(7):711–719. Zheng X , Peng C , Gao M .2019. Risk factors for cervical lymph node metastasis in papillary thyroid microcarcinoma: a study of 1,587 patients. Cancer Biol Med. 2019;16(1):121–130. 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Also discoverable on Platform About In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-133510","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":7711180,"identity":"b879ba83-71fd-47e9-bb9b-fc782319e74a","order_by":0,"name":"Lin Han","email":"","orcid":"","institution":"Taishan Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Lin","middleName":"","lastName":"Han","suffix":""},{"id":7711181,"identity":"e247143b-d391-4498-b77a-3b07d384669d","order_by":1,"name":"Zhen Wu","email":"","orcid":"","institution":"Taishan Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhen","middleName":"","lastName":"Wu","suffix":""},{"id":7711182,"identity":"546a0c02-b001-4727-b5f7-54176693a16c","order_by":2,"name":"Wenlei Li","email":"","orcid":"","institution":"Taishan Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wenlei","middleName":"","lastName":"Li","suffix":""},{"id":7711183,"identity":"f3167d18-465f-4c1c-8582-81296eca4864","order_by":3,"name":"Yingxue Li","email":"","orcid":"","institution":"Taishan Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yingxue","middleName":"","lastName":"Li","suffix":""},{"id":7711184,"identity":"efefaeb9-7c67-463c-a815-dd698f26bf04","order_by":4,"name":"Jinglin Ma","email":"","orcid":"","institution":"Taishan Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jinglin","middleName":"","lastName":"Ma","suffix":""},{"id":7711185,"identity":"cb73bac6-1cf9-45e2-a70b-6065bf7da492","order_by":5,"name":"Xinxin Wu","email":"","orcid":"","institution":"Taishan Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xinxin","middleName":"","lastName":"Wu","suffix":""},{"id":7711186,"identity":"8e7d1150-7975-4ac0-9607-62683242ad9b","order_by":6,"name":"Wenjuan Wen","email":"","orcid":"","institution":"Taishan Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wenjuan","middleName":"","lastName":"Wen","suffix":""},{"id":7711187,"identity":"ce2ca30b-85d8-436a-85da-2f58448bd3fe","order_by":7,"name":"Rui Li","email":"","orcid":"","institution":"Taishan Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Rui","middleName":"","lastName":"Li","suffix":""},{"id":7711188,"identity":"7808cee5-6186-4162-b98a-ac5fca830620","order_by":8,"name":"Yumin Yao","email":"","orcid":"","institution":"Taishan Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yumin","middleName":"","lastName":"Yao","suffix":""},{"id":7711189,"identity":"6987b6a9-69a7-445f-9d5e-21906c6b19c6","order_by":9,"name":"Yongkun Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIie3PMUvDQBjG8QsHN70l650VP8PFQGyxJF8lEuh0du54UnAKdE2wn8P5yoFdol0DdRAKLmZItgwdzFKdeukoeL/xeP7wHkKW9ZdRhJyPup2A68rzE+zl6fSSZer8hAyB6AmXsXnJN6/6C+bvYZ7dv1CALXCknLoRhqSYTW+h+Eye6CwZ0dEObrDELH8+nQRKBP7gUSdXVHglhx2MpSJ4YEq21U/CaUzegKu4JymFv++ScEjFNVVE9SdRWQXOqtAxSyvfe0gTYNl6YfwLWwq/ruY6ohvh7Q9tGLnuYl03hqRDLgChO/n74MhT0yPctN2BfSvLsqx/7Bs6ylTkYzMA6gAAAABJRU5ErkJggg==","orcid":"","institution":"Taishan Medical University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Yongkun","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2020-12-21 19:29:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-133510/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-133510/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":4818370,"identity":"21852d89-3696-4da4-9484-0e0370436b70","added_by":"auto","created_at":"2021-01-08 19:13:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":399567,"visible":true,"origin":"","legend":"Histology types of thyroid cancer identified in this study. A. Classical type PTC. B. Follicular variant PTC. C. Tall cell variant PTC. D. Solid variant PTC. All images are 40× magnification.","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-133510/v1/5303acd71081e5afc04b2774.png"},{"id":4818347,"identity":"f489e66a-f32e-4152-b06f-83a3e699cd4f","added_by":"auto","created_at":"2021-01-08 19:10:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":64832,"visible":true,"origin":"","legend":"Numbers of cases of thyroid cancer treated at our hospital in the past 9 years.\n ","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-133510/v1/b2f7beb0bb308009d24e4e15.png"},{"id":13644068,"identity":"84fc8e68-f347-4b9a-8778-ed46e8f80e40","added_by":"auto","created_at":"2021-09-17 09:14:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":869215,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-133510/v1/879b63f5-0bee-4bab-a76f-f31ba2db4c0a.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003e2108 Cases of Thyroid Cancer:\u0026nbsp;Cervical Lymph Node Dissection or Not\u003c/p\u003e","fulltext":[{"header":"Introduction","content":" \u003cp\u003eIn the past 30 years, the incidence of thyroid cancer has been increasing annually worldwide, with the incidence in China also rising. In 2012, the number of new cases and deaths from thyroid cancer in China accounted for 15.6% and 13.8%, respectively, of the global total. It is estimated that by 2019, thyroid cancer will become the third most common malignancy in women in the United States, leading to medical expenditure of approximately \u003cspan\u003e$\u003c/span\u003e19\u0026ndash;21\u0026nbsp;billion, representing a heavy economic burden on both society and individuals(La Vecchia C et al.2015).\u003c/p\u003e \u003cp\u003eDifferentiated thyroid carcinoma accounts for 80\u0026ndash;90% of thyroid cancer incidence and the most common metastasis is to the cervical lymph nodes, which seriously influences patient prognosis. Therefore, effective and appropriate surgical treatment of differentiated thyroid carcinoma is of great clinical significance. Total thyroidectomy and lobectomy remain the main primary surgical interventions for thyroid carcinoma. To date, there has been no large sample randomized controlled clinical trial to compare these two methods, hence their relative efficacy remains controversial and comparative studies have relied mainly on retrospective analyses(Bilimoria K et al.2007). This indicates that although papillary thyroid carcinoma(PTC) progress is slow, the ability and tendency to metastasize to lymph nodes and even distant organs are consistent with other malignancies. In generally, it is unscientific to classify malignant tumors based on tumor size. The invasiveness and distant metastatic ability of tumors are derived from the evolution of the tumor genome(Ito Y et al.2018,Vigneri R et al.2015).There are still different opinions on whether to perform preventive lateral neck lymph node dissection. The focus of debate is on the following aspects: Preventive lateral neck lymph node dissection needs to expand neck incision and affect appearance; Lateral neck lymph node dissection can cause shoulder syndrome, which seriously affects the patient's quality of life; Differentiated thyroid cancer is slow to develop, as long as it is closely followed by diagnosis, allowing treatment when suspicious lymph nodes are found(Wu X et al.2019,Mendelsohn AH et al.2010).\u003c/p\u003e \u003cp\u003eWe collected clinical and pathological data from 2108 patients undergoing treatment at the Department of Thyroid Surgery, Liaocheng People\u0026rsquo;s Hospital, and analyzed their responses to current treatment approaches. Using accurate clinical data, we aimed to settle the controversy about appropriate treatments for thyroid cancer and determine the most appropriate initial surgical intervention for patients in China with this condition.\u003c/p\u003e "},{"header":"Methods","content":" \u003cp\u003eThis study was a retrospective analysis of a total of 2108 cases of PTC treated and undergoing surgery from January 1 to December 31, 2018 in the Department of Thyroid Surgery, Liaocheng People\u0026rsquo;s Hospital, Clinical Hospital of Shandong First Medical University, China. All patients underwent fine needle aspiration before surgery, and had pathological diagnoses of papillary carcinoma or suspected papillary carcinoma.\u003c/p\u003e \u003cp\u003eSurgical procedures were as follows: 1001 cases were treated with total thyroidectomy\u0026thinsp;+\u0026thinsp;central node dissection. Total thyroidectomy\u0026thinsp;+\u0026thinsp;central lymph node dissection\u0026thinsp;+\u0026thinsp;lateral neck node dissection were performed in 1107 cases. For patients\u0026thinsp;\u0026lt;\u0026thinsp;18\u0026nbsp;years old, informed consent was obtained from both parents.\u003c/p\u003e \u003cp\u003eSurgical methods were based on the guidelines of Chinese Thyroid Cancer (CTA), following the experience of clinical professors. We confirm that all methods were performed in accordance with the relevant guidelines.\u003c/p\u003e \u003cp\u003eWritten informed consent for participation in this study was obtained from each patient after full explanation of the purpose and nature of all procedures used. All patients agreed to receive total thyroidectomy. The study was conducted in accordance with the Declaration of Helsinki. The ethical approval number is 2016071.\u003c/p\u003e \u003cp\u003eBefore surgery, patients and their families were fully informed and discussed the implications.\u003c/p\u003e \u003cp\u003ePathological data were obtained from the Department of Pathology, Liaocheng People\u0026rsquo;s Hospital, Clinical Hospital of Shandong First Medical University, and were based on post-operative analysis of paraffin-embedded tumor samples. Pathological data were stored in a unified database, and comprise standard information, including preoperative fine needle biopsy cytology pathology, intraoperative rapid frozen pathology, and postoperative routine paraffin pathology. Information on all patients was systematically coded in a single computer file. Data from this system were exported for statistical analyses.\u003c/p\u003e "},{"header":"Results","content":" \u003cp\u003eAll patients were treated directly after discovery of the lesion, without any observation period. Cases included 416 males and 1692 females, and were 13\u0026ndash;79\u0026nbsp;years old, with 285 cases aged\u0026thinsp;\u0026le;\u0026thinsp;35\u0026nbsp;years (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe age and gender of patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003etotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e566\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e511\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e619\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e402\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e489\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e253\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe pathological subtypes present among the 552 cases of PTC were classical (n\u0026thinsp;=\u0026thinsp;537), follicular variant (n\u0026thinsp;=\u0026thinsp;12), tall cell variant (n\u0026thinsp;=\u0026thinsp;2), and solid variant (n\u0026thinsp;=\u0026thinsp;1). The main diagnostic features of the classical variant (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA) are papillary structures and nuclear features, including enlarged nuclei, increased nuclear/cytoplasmic (N/C) ratio, nuclear grooves, and nuclear pseudo-inclusions. The follicular variant of PTC also has nuclear features, but not papillary structures (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB), while the tall cell variant is composed of epithelial cells that have a height-to-width ratio exceeding 3:1, with abundant eosinophilic cytoplasm (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eC). The solid variant of PTC is characterized by solid nests of epithelial cells with well-defined borders, but which fail to form follicles and lack colloid storage (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eD). Both classical type and the follicular variant PTC are associated with similar prognosis, and together these accounted for 99.5% of our cases. The tall cell variant and the solid variant are associated with more aggressive tumor behavior compared with classical PTC.\u003c/p\u003e \u003cp\u003eThere were 2,108 cases of thyroid papillary carcinoma, 1,001 cases of total thyroidectomy\u0026thinsp;+\u0026thinsp;central lymph node dissection, and 1107 cases of total thyroid dissection\u0026thinsp;+\u0026thinsp;central lymph node dissection\u0026thinsp;+\u0026thinsp;cervical lymph node dissection. The average metastasis rate was 57.23%. The proportion of metastasis was positively correlated with tumor diameter, from 36.22\u0026ndash;77.22%. However, T3 patients may have a low rate of lymph node clearance due to irregular surgical treatment or intraoperative surgery strategies, resulting in deviations in data(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e,\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The proportion of thyroid micropapillary carcinoma was 55.12%, and the lymph node metastasis rate was 48.97%(Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThyroid cancer diameter and metastasis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMetastasis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRatio\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT1a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e442\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.97%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e36.20%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e720\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.16%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e409\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e56.81%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e604\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.65%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e70.86%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e316\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.99%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e77.22%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.23%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e65.38%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e57.23%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe diameter and metastasis of thyroidectomy\u0026thinsp;+\u0026thinsp;central node dissection\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMetastasis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRatio\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT1a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.97%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e33.00%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e370\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.96%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e45.95%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.48%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50.64%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.49%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e48.24%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.10%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e45.45%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e434\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e43.36%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe proportion and clinical characteristics of patients with papillary thyroid microcarcinoma.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eproportion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003emetastasis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eproportion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ecentral lymph node\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eproportion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003elateral neck lymph node\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eproportion\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55.12%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e569\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.97%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e405\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34.85%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e14.11%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThere were 773 bilateral tumors, accounting for 35.17%, and the transfer rate was 65.27%. There were 547 cases of multiple tumors, accounting for 24.89%, the transfer rate was 72.21%, and 343 cases of bilateral combined multiple tumors, accounting for 15.61%, and the transfer rate was 74.05%.There were 483 cases of tumor broke through the membrane, accounting for 22.91%, and the metastasis rate was 67.08%.(Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e) When the tumor is combined with bilateral, multiple, and breakthrough membranes, the metastasis rate is higher than the average transfer rate, and the analysis has statistical significance.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe surgery and high-risk factors of thyroid cancer.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMetastasis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRatio\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBilateral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e773\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35.17%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e508\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e65.27%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiple\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e547\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.89%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e395\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e72.21%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.61%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e74.05%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCapsule invasion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e483\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.91%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e324\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e67.08%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn 1001 cases, only central lymph node clearance was performed, accounting for 47.48%, and the transfer rate was 41.86%. In 1107 patients, cervical lymph nodes were increased, accounting for 52.51%, and the transfer rate was 74.44%(Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). With the increase in tumor diameter, the overall metastasis rate increased from 42.96\u0026ndash;87.88%, of which patients with T3 may have a relationship with surgical treatment or surgical strategy during surgery, and the lymph node metastasis rate(80%) is lower than that of T2(87.88%), there's a discrepancy in the data(Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e). The metastasis rate of cervical lymph nodes was also positively correlated with tumor diameter, from 22.54\u0026ndash;73.33%. Neck lateral metastasis occurred in 546 of all tumors, accounting for 49.32%(Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe metastasis of thyroid cancer.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMetastasis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRatio\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal thyroidectomy\u003c/p\u003e \u003cp\u003ecentral lymph node dissection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.48%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e419\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e41.86%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal thyroidectomy\u003c/p\u003e \u003cp\u003ecentral lymph node dissection\u003c/p\u003e \u003cp\u003elateral neck node dissection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52.51%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e824\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e74.44%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe metastasis of lateral neck node.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMetastasis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCervical\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eT1a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.83%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.96%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.54%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eT1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e350\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.62%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.29%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.71%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eT1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e369\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e309\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e210\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.33%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.74%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.91%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e203\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.87%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87.88%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.69%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eT3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.35%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73.33%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCollection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e824\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e546\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74.44%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.32%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e25.56% of patients had negative lymph nodes in the central and neck regions, and 25.11% of patients had only central lymph node metastasis, that is, 50.67% of patients had cervical lymph nodes that were safe. The proportion of patients with metastasis in both the central area and the neck area was 42.55%, of which 39.49% were from T1c patients. In all patients with positive lymph nodes in the central area, 62.88% of the patients had cervical metastasis. Only 6.78% of patients had jump metastasis, that is, the central lymph nodes were negative, and cervical lymph node metastasis occurred, of which T1c patients accounted for 30.67%, T1c and above patients accounted for 78.55%(Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe metastasis of central and lateral neck node.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecervical\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT1a\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eT1b\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eT1c\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eT3\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0\u0026ndash;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e283\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.56%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.62%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.22%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.55%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.89%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.71%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0\u0026ndash;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.78%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.67%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.67%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26.67%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1\u0026thinsp;\u0026minus;\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e278\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.11%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.43%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.49%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.25%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15.11%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.72%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1\u0026ndash;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e471\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.55%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.46%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39.49%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29.94%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.69%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOf the patients with T1a, 57.04% did not have metastasis. In T1b, there was no metastasis in 31.71% of lymph nodes, 30.57% had only central lymph node metastasis, and 32.57% had metastasis in Central and neck regions. In T1c patients, 50.41% of patients had metastasis. In T2 patients, the metastasis rate was 61.04%, and in T3 patients, it was as high as 53.3%(Table\u0026nbsp;\u003cspan refid=\"Tab9\" class=\"InternalRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab9\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe diameter and metastasis of cervical lymph node.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecervical\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026ndash;0\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u0026ndash;1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u0026thinsp;\u0026minus;\u0026thinsp;0\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u0026ndash;1\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eT1a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.04%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20.42%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.79%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eT1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e350\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.71%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.14%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.57%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32.57%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eT1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e369\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.23%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26.56%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50.41%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.12%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.66%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.18%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e61.04%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eT3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.33%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.33%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e53.33%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn addition, we enumerated the number of cases of surgery for thyroid cancer at our hospital from 2009\u0026ndash;2018 and the results demonstrate that the number of cases generally rose annually by 4.72\u0026ndash;18.16% (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e "},{"header":"Discussion","content":"\u003cp\u003eAccording to the results of the SEER database of the National Cancer Center of the United States, the incidence of both PTC\u0026thinsp;\u0026lt;\u0026thinsp;1.0\u0026nbsp;cm and thyroid cancers 1.0\u0026ndash;4.0\u0026nbsp;cm increased from 1980 to 2010, especially among highly educated groups(Alwithenani R et al.2019). Statistical data from the United States and South Korea show an increase in the incidence of thyroid cancer(Jingqiang Z et al.2016). Further, the results of surveys in Denmark, Finland, Israel, Japan, Spain, and Switzerland also demonstrate increases in thyroid cancer incidence, which is mainly PTC, with significant sex differences in the relative extent of the rise. This phenomenon cannot be fully explained by improvements in the sensitivity of testing methods, nor increased awareness among doctors and patients of screening(McDow AD et al.2019). Scholars from other countries have actively researched the risk factors associated with thyroid cancer, and found that autoimmune disorders, ionizing radiation, iodine intake, estrogen, environmental endocrine disruptors, negative psychosocial factors, and heredity may contribute to increases in thyroid cancer incidence(Huang T.2016,Dettmer MS et al.2019).\u003c/p\u003e\n\u003cp\u003eFrom 1984 to 2010, the incidence of differentiated thyroid carcinoma in the United States increased, with tumors of diameter\u0026thinsp;\u0026le;\u0026thinsp;0.5 rising by 5.09%, while those of 0.5\u0026ndash;0.99\u0026nbsp;cm in diameter increased by 8.45%, average diameter tumors (1.0\u0026ndash;1.99\u0026nbsp;cm) by 3.42%, and large tumors\u0026thinsp;\u0026ge;\u0026thinsp;2.0\u0026nbsp;cm by 2.96%. These data suggest that most PTMCs will develop into tumors with diameter\u0026thinsp;\u0026gt;\u0026thinsp;1\u0026nbsp;cm, but over varying periods of time. In particular, the possibility of dedifferentiation increases with prolonged tumor-bearing time and patient age(Dong F et al.2016,Li N et al.2013). It is generally recognized that, over time, the degree of malignancy and dedifferentiation of PTC tumors increases; however, when the level of malignancy changes, what causes changes in the tumor genome has not been fully or satisfactorily explained(Ahn HS et al.2014).\u003c/p\u003e\n\u003cp\u003eAs available therapies for thyroid cancer are effective, there is little drive for early diagnosis and surgical treatment, which is counterintuitive and violates the basic principles of pursuing early detection, with the aim of early diagnosis and treatment of malignant tumors. In addition, the psychological pressure on patients of the uncertainty of following up while waiting for the diagnosis of malignancies to change before taking action, is undoubtedly considerable. Cancer does not have specific Chinese characteristics. In 2014, the Memorial Sloan-Kettering Cancer Center in the United States launched a \u0026ldquo;wait-and-see\u0026rdquo; program for patients with thyroid cancer(Pellegriti G et al.2013). Patients diagnosed with microcarcinoma of the thyroid could choose not to have it removed for a while, but rather to have it checked regularly; however, the vast majority of patients with PTMC did not hesitate to choose surgical treatment. Further, some patients who chose the observation option eventually asked for surgery, and doctors feared being sued for missing the optimal treatment time. Early treatment is not only effective, it is also associated with reduced risk and fewer complications(Choi WR et al.2019). Once lymphatic metastases, or distant lung and bone metastases, occur, the cost of medical care often increases considerably, which can even endanger the life of the patient.\u003c/p\u003e\n\u003cp\u003eAccording to our clinical and pathological data, as the diameter of the mass increases, the proportion of lymph node metastasis increases, from 44.68\u0026ndash;77.53%. The proportion of micropapillary carcinoma\u0026thinsp;\u0026le;\u0026thinsp;1 was 47.10%, and the rate of lymph node metastasis was 46.92%, which did not mean that the risk of microcarcinoma was low. Lymph node metastasis is also an indicator of malignancy. With the passage of time, the tumor size, the proportion and the number of lymph node metastasis will further increase, leading to the disease progression, the difficulty and risk of surgery, and the risk of recurrence and metastasis gradually increased. When the mass rises above 2\u0026nbsp;cm, the lymph node metastasis ratio rises to 77.53%, indicating that thyroid papillary carcinoma is progressing, the malignant degree and the disdifferentiation increases, although there is no way to evaluate and predict it.\u003c/p\u003e\n\u003cp\u003eCompared with the National Comprehensive Cancer Network (NCCN) and the American Thyroid Association (ATA) guidelines for the diagnosis and treatment of differentiated thyroid cancer, Chinese guidelines for patients undergoing thyroid surgery to remove all indications do not include any specific age-based requirements. The NCCN guidelines recommend that patients with PTC aged\u0026thinsp;\u0026lt;\u0026thinsp;15 or \u0026gt;\u0026thinsp;45\u0026nbsp;years should undergo total thyroidectomy. While the ATA guidelines recommend total thyroidectomy for all patients with PTC with tumor diameters\u0026thinsp;\u0026gt;\u0026thinsp;1\u0026nbsp;cm, unlike Chinese guidelines. Further, total thyroidectomy is also recommended for all patients with thyroid nodules in the contralateral gland and for patients with PTC with tumor diameters 1.0\u0026ndash;1.5\u0026nbsp;cm, aged\u0026thinsp;\u0026gt;\u0026thinsp;45\u0026nbsp;years. In addition, Chinese guidelines indicate that all patients with differentiated thyroid cancer should receive central region lymph node dissection, as this provides effective protection from recurrent laryngeal nerve and parathyroid gland involvement. The NCCN and ATA guidelines recommend no dissection of the central lymph node without involvement, except for abnormal palpation or clear metastasis diagnosed by puncture biopsy. Total thyroidectomy can have advantages for patients, including: 1) single treatment of multiple lesions, particularly bilateral cancer lesions; 2) facilitates postoperative monitoring of tumor recurrence and metastasis; 3) beneficial for postoperative I\u003csup\u003e131\u003c/sup\u003e treatment; 4) reduces the recurrence rate of tumors and the probability of reoperation, which avoids increasing the incidence of serious complications due to reoperation; 5) accurate assessment of postoperative staging and risk stratification of patients; 6) prevention of recurrence of thyroid cancer from development into poorly differentiated thyroid cancer.\u003c/p\u003e\n\u003cp\u003eThe bilateral tumor metastasis rate is 65.27%, the recurrent cancer metastasis rate is 72.21%, the tumor breakthrough membrane metastasis rate is 67.08%, and the metastasis rate is higher than the average metastasis rate. The analysis is statistically significant. When combined with high risk factors, such as bilateral lesions, multiple lesions and tumor rupture membranes, the lymph node metastasis rate will increase significantly(Ruggiero R et al.2019). It is recommended that we conduct more comprehensive preoperative clinical assessments to facilitate us to obtain more comprehensive patient disease information. Thyroidectomy and central lymph node dissection may be more reasonable, thorough, and safe procedures for clinicians to consider.At present, some preoperative examinations used in clinical practice cannot reveal suspected cancer lesions in the contralateral glandular lobe. Total thyroidectomy completely removes any such lesions and glands with potential lesions, thereby avoiding the risk of undetected cancer lesions, reducing the recurrence rate, and improving patient prognosis(Zheng X et al.2019,Chen Y et al.2014). In patients with PTC, thyroid globulin levels can be assessed postoperatively to determine whether there is residual tumor or recurrence. For patients with all thyroid tissue removed, there should be no thyroid globulin present in the body; hence, if thyroid globulin is detected in the serum, it generally indicates that some lesion remains or has relapsed, which is also an important prognostic indicator.\u003c/p\u003e\n\u003cp\u003eTotal thyroidectomy increases the incidence of recurrent laryngeal nerve and parathyroid gland injury, and any complications will have a serious impact on the mental health and quality of life of patients postoperatively. Therefore, surgeons must receive strict guidance and training to reduce or avoid surgical complications. Doctors undergoing training who may conduct lateral\u0026thinsp;+\u0026thinsp;isthmus\u0026thinsp;+\u0026thinsp;contralateral subtotal thyroidectomy should ensure that very small amounts of non-tumor thyroid tissue is left on the contralateral glandular lobe only to avoid recurrent disease of the laryngeal nerve and around the parathyroid gland. Simultaneously, in combination with the application of nano-carbon and nerve monitoring during surgery, to avoid bilateral recurrent laryngeal nerve or parathyroid gland damage, residual thyroid tissue can be dealt with using radioactive I\u003csup\u003e131\u003c/sup\u003e therapy following surgery.\u003c/p\u003e\n\u003cp\u003eThe cervical lymph node metastasis rate was also positively correlated with the tumor diameter. In all tumors, 49.32% of patients had cervical regional metastasis, of which 69.40% were T1c and above tumor patients. Of the patients with T1c, 76.97% had central lymph node metastasis, of which 65.50% had cervical lymph node metastasis at the same time. Although only 6.78% of patients had jump metastasis, T1c patients accounted for 30.67%, and T1c and above patients accounted for 78.55%. It is suggested that when we treat T1c patients, we should fully evaluate the preoperative evaluation. As far as possible, the original lesion and metastatic lesion should be cleaned together during the initial operation to avoid reoperation. The surgical method can consider cervical lymph node clearance.Thyroid cancer has a good prognosis and long survival. Therefore, we should try our best to protect the function of the tumor while improving the quality of life. It is recommended to keep the sternocleidomastoid, the internal jugular vein and the accessory nerve, and try to keep the cervical plexus neurocutaneous branch. At present, the modified radical neck dissection (MRND) is the most commonly used procedure for both thorough surgery and preservation of the body function. Lymph node metastasis of thyroid papillary carcinoma is common to the ipsilateral side, and it is transferred along the lymphatic drainage path. The lymphatic metastasis is usually first to the paratracheal lymph node, and then drained to the jugular vein lymph node (levelⅡ-Ⅳ) and the posterior cervical lymph nodes (levelⅤ), or down the trachea to the upper mediastinum. The most common site in the 6th district, followed by the neck Ⅲ,Ⅳ,Ⅱ,Ⅴlevel, and the lymph node metastasis of papillary thyroid carcinoma is mainly metastasis.\u003c/p\u003e\n\u003cp\u003eAt present, surgical treatment of cervical lymph node metastasis of papillary thyroid carcinoma is recommended for the treatment of cervical lymph node dissection. Prophylactic dissection is not recommended. The occult metastasis of cervical lymph nodes does not reduce the survival rate of patients, so prophylactic cervical lymph node dissection is not recommended in patients with cN0.\u003c/p\u003e\n\u003cp\u003eFor patients with cN1, lymph node metastasis is an independent risk factor for the survival of patients with \u0026gt;\u0026thinsp;45-year-old papillary thyroid carcinoma(Hodax JK et al.2019,Morris LG et al.2016). levelⅡ-Ⅳis the main area of thyroid lymphatic drainage, and levelⅢ,Ⅳis the most common lymph node metastasis. Domestic experts agree that levelⅡa,Ⅲ,Ⅳ,Ⅴb is the standard range of cervical lymph node dissection(Yan L et al.2019). It is recommended that patients with cervical lymph node metastasis confirmed by preoperative evaluation or intraoperative frozen pathological examination receive cervical lymph node dissection, but preventive cervical lymph node dissection is not recommended(Kaliszewski K et al.2019).Reoperation will increase the complications of surgery, and it will lead to recurrence of disease after thyroid cancer surgery, and even affect survival. At the same time, as the number of operations increases, the degree of tumor dedifferentiation will increase, and the difficulty and risk of surgery will increase. It is impossible to completely remove the surgery again, so that the patient who can be cured can lose the opportunity to cure(Eanaola NF et al.2002,Gimm O et al.2002).\u003c/p\u003e\n\u003cp\u003eThyroidectomy can lead to complications, primarily parathyroid injury (3\u0026ndash;5%) and recurrent laryngeal nerve injury (1\u0026ndash;5%). It is accepted that patients who undergo total or partial thyroidectomy must use thyroxine replacement, or even suppression, therapy for the rest of their lives(Haugen BR et al.2016,Polistena A et al.2017). Data from our hospital related to hypocalcemia, hoarseness, and sensory dysfunction of the shoulder after thyroid surgery currently undergoing statistical analysis and will be presented in future reports. The pathological characteristics of PTC mean that analysis of the influence of surgical approach on survival and prognosis will be a long-term project, and we will continue to analyze follow-up data for these patients. Only a small number of patients were found to have BRAF gene mutations in our study, as there is no comprehensive promotion of genetic testing in our hospital, hence not all patients were evaluated.\u003c/p\u003e\n\u003cp\u003eAccording to the CTA, endocrine inhibition therapy is essential, regardless of surgical approach. Hence, long-term endocrine suppression therapy was required for all patients with PTC, including those who underwent lobectomy\u0026thinsp;+\u0026thinsp;central lymph node dissection. Radioactive I\u003csup\u003e131\u003c/sup\u003e therapy is also an important part of comprehensive treatment of thyroid cancer(Yang T et al.2019,Conzo G et al.2014). All patients with lymph node metastasis, whether in the central or cervical region, were treated with I\u003csup\u003e131\u003c/sup\u003e administered at doses of 80\u0026ndash;130\u0026nbsp;mCi, according to risk stratification assessment, with additional rounds of treatment if needed, based on the results of follow-up observation.\u003c/p\u003e\n\u003cp\u003eThe method of treatment of thyroid cancer is influenced not only by surgeons, but also by nuclear medicine, imaging, and other clinicians, and even by health insurance companies. Careful preoperative staging and risk stratification of thyroid carcinoma results in better outcomes for patients with thyroid carcinoma. This is because such an approach facilitates more accurate surgery, and individualized treatment, as well as allowing collection of data on national trends in this disease. The authors consider that surgeons should fully embrace the principles of tumor prevention and treatment, and be mindful that thyroid cancer is a malignant tumor; hence, the scope of treatment should not be reduced unnecessarily, to avoid the need for reoperation several years later. Therefore, it is necessary to assess patients, according to current scientific knowledge, to make a comprehensive judgment of the safety of surgery, the willingness of the patient, and medical resources available, together with the national considerations and regional factors in China, and the degree of acceptance of the operation and possible secondary surgery by the patient. Together, this information can inform implementation of rational diagnosis and treatment plans.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePTC:papillary thyroid carcinoma\u003c/p\u003e\n\u003cp\u003ePTMC:papillary thyroid microcarcinoma\u003c/p\u003e\n\u003cp\u003eCTA:Chinese Thyroid Cancer\u003c/p\u003e\n\u003cp\u003eNCCN:National Comprehensive Cancer Network\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eATA:American Thyroid Association\u003c/p\u003e\n\u003cp\u003eMRND:modified radical neck dissection\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe data from our department inform several important points. 1. The incidence of thyroid cancer cases in our hospital generally rose annually during 2009\u0026ndash;2018 from a minimum of 247 to a maximum of 600 (increase rates from 4.72%\u0026ndash;18.16%); hence, thyroid cancer has become a common malignancy threatening the physical and mental health of patients and representing a dark psychological shadow and economic burden on both individuals and society. 2. PTC, even PTMC, has a high rate of local metastasis (57.23% and 48.97%, respectively) as, although it is an inert tumor after recovery, high invasiveness can occur on evolution of the tumor genome, indicating that it cannot be considered to exhibit a low degree of malignancy, suggesting that we should give more active and thorough treatment. 3. When there were complications, such as bilateral lesions, multiple lesions,and tumor breakthrough membranes, tumors were highly aggressive, suggesting that priority should be given to total central thyroidectomy lymph node dissection. Postoperative complications and long-term follow-up data will be reported in the future. 4. There is no need to prevent cervical lymph node clearance, but when the mass reaches T1c, the risk of central area, neck side area and jump type metastasis is obviously high. It is recommended to give cervical side lymph node clearance so that it is more complete and safer.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eAuthors\u0026rsquo; contributions\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eAll authors contributed equally, there is no sequence. Yongkun Wang and Zhen Wu were responsible for the study design.Wenlei Li an Lin Han were responsible for data interpretation. Yingxue Li and Jinglin Ma were responsible for writing the manuscript. Wenjuan Wen and Xinxin Wu were responsible for conducting the literature search. Yumin Yao and Rui Li were responsible for data analyses. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgments\u003c/h2\u003e\n\u003cp\u003eWe thank Shandong First Medical University and Liaocheng People\u0026rsquo;s Hospital for supporting this study, and also the pathology and thyroid surgery staff for their support and assistance in conducting this study. We thank everyone involved in this study for their hard work.\u003c/p\u003e\n\u003ch2\u003eCompeting Interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and material\u003c/h2\u003e\n\u003cp\u003eWe confirm that we will share the data underlying the findings reported in this manuscripts and allow researchers to verify the results presented, replicate the analysis, and conduct secondary analyses.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll medical records are legal and reasonable. The study was approved and supervised by the ethics committee of Liaocheng People\u0026rsquo;s Hospital, affiliated to Shandong First Medical University.\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sectors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAhn HS, Kim HJ, Welch HG.2014. 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Risk factors for cervical lymph node metastasis in papillary thyroid microcarcinoma: a study of 1,587 patients. \u003cem\u003e\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/31119052\"\u003eCancer Biol Med.\u003c/a\u003e\u003c/em\u003e 2019;16(1):121\u0026ndash;130.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"thyroid cancer, metastasis, surgery, real world, initial treatment","lastPublishedDoi":"10.21203/rs.3.rs-133510/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-133510/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBased thyroid cancer data from patients treated in Liaocheng People\u0026rsquo;s Hospital from 2015 to 2018, with Chinese national and regional characteristics, in this study we addressed the controversy of which initial thyroid surgical mode, lobectomy or total thyroidectomy, is most effective. Clinical and pathological data from 2108 patients with thyroid cancer, who were initially diagnosed and treated surgically, were collected from the Department of Thyroid Surgery. The overall metastasis rate of all patients was 57.23%.With the increase of tumor diameter, the metastasis of cervical lymph nodes ranged from 22.54\u0026ndash;73.33%, which showed positive correlation.49.32% of patients had lymph node metastasis in the lateral cervical region.When the diameter of the tumor reached T1c level, the metastasis of the cervical lymph nodes was 56.91%, and the number of metastatic cases above T1c level accounted for 69.96% of the total metastatic cases. It is recommended that initial treatment should comprise at least total thyroidectomy\u0026thinsp;+\u0026thinsp;central lymph node dissection in China, to avoid the risks associated with secondary surgery and effects on patient quality of life.When the tumor diameter exceeds 1\u0026nbsp;cm, the risk of cervical lymph node metastasis is high, we recommended the lateral lymph node dissection.\u003c/p\u003e","manuscriptTitle":"2108 Cases of Thyroid Cancer:\u0026nbsp;Cervical Lymph Node Dissection or Not","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-01-08 19:10:42","doi":"10.21203/rs.3.rs-133510/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"aae88511-fd4e-4143-b774-c3111b4488f9","owner":[],"postedDate":"January 8th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":1792278,"name":"Health Economics \u0026 Outcomes Research"},{"id":1792279,"name":"Cancer Biology"},{"id":1792280,"name":"Oncology"},{"id":1792281,"name":"Scientific Communication"}],"tags":[],"updatedAt":"2021-01-11T13:59:24+00:00","versionOfRecord":[],"versionCreatedAt":"2021-01-08 19:10:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-133510","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-133510","identity":"rs-133510","version":["v1"]},"buildId":"DiO0y1XJrWGSkZWLOoVa_","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}