Predictors of central lymph node metastasis in papillary thyroid carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Wen ,  CHENG Ruochuan

Diagnosis and Treatment Center of Thyroid Disease, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, P. R. China;

Corresponding author：

CHENG Ruochuan, Email: cruochuan@foxmail.com

Keywords：

papillary thyroid carcinoma; central lymph node metastasis; prophylactic central lymph node dissection; review

DOI：

10.7507/1007-9424.201706093

Video：

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Objective To summarize the influencing factors of central lymph node metastasis in thyroid papillary carcinoma. Method Relevant literature about papillary thyroid carcinoma were reviewed and predictive factors of central lymph node metastasis were summarized. Results Studies had shown that, male, younger age, larger tumor size, multifocal, and BRAF mutations were risk factors for central lymph node metastasis in thyroid papillary carcinoma, while tumors located in the upper pole and combined with Hashimoto disease (HT) were the protective factors for central lymph node metastasis. Conclusions The central lymph node metastasis detection rate is low, so it is unable to meet with the preoperative diagnosis in papillary thyroid carcinoma. A large number of studies have confirmed that clinical pathological features have predictive value for preoperative lymph node diagnosis, and can provide a reference for the selection of surgical methods in thyroid papillary carcinoma.

Citation： LIU Wen, CHENG Ruochuan. Predictors of central lymph node metastasis in papillary thyroid carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(1): 99-103. doi: 10.7507/1007-9424.201706093 Copy

1.	WHO, IARC. International agency for research on cancer. World Cancer Report 2014. Lyon: IARC Press, 2014: 738-750.
2.	Dal Maso L, Lise M, Zambon P, et al. Incidence of thyroid cancer in Italy, 1991-2005: time trends and age-period-cohort effects. Ann Oncol, 2011, 22(4): 957-963.
3.	Mao LN, Wang P, Li ZY, et al. Risk factor analysis for central nodal metastasis in papillary thyroid carcinoma. Oncol Lett, 2015, 9(1): 103-107.
4.	刘文, 程若川, 苏艳军, 等. 2015 版美国甲状腺协会指南 cN0 甲状腺乳头状癌手术方案合理性分析. 中国实用外科杂志, 2017, 37(5): 568-571.
5.	Amin MB, Greene FL, Edge SB, et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more " personalized” approach to cancer staging. CA Cancer J Clin, 2017, 67(2): 93-99.
6.	Chéreau N, Buffet C, Trésallet C, et al. Recurrence of papillary thyroid carcinoma with lateral cervical node metastases: Predictive factors and operative management. Surgery, 2016, 159(3): 755-762.
7.	刘文, 程若川, 苏艳军, 等. 甲状腺微小乳头状癌 rⅥb 区转移预测因素及 rⅥa 区、rⅥb 区转移相关性研究. 中国实用外科杂志, 2017, 37(9): 1007-1012.
8.	NCCN. The NCCN Thyroid Carcinoma Clinical Practice Guidelines in Oncology (Version 2.2017). 2017-05-17. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp.
9.	Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 2016, 26(1): 1-133.
10.	Gharib H, Papini E, Garber JR, et al. American Association of Clinical Endocrinologists, American College of Endocrinology and Associazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules-2016 update executive summary of recommendations. Endocr Pract, 2016, 22(5): 622-639.
11.	中华医学会内分泌学分会, 中华医学会外科学分会, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南. 中国肿瘤临床, 2012, 39(17): 1249-1272.
12.	Lee DW, Ji YB, Sung ES, et al. Roles of ultrasonography and computed tomography in the surgical management of cervical lymph node metastases in papillary thyroid carcinoma. Eur J Surg Oncol, 2013, 39(2): 191-196.
13.	Khokhar MT, Day KM, Sangal RB, et al. Preoperative high-resolution ultrasound for the assessment of malignant central compartment lymph nodes in papillary thyroid cancer. Thyroid, 2015, 25(12): 1351-1354.
14.	刘文, 闫雪晶, 程若川, 等. 甲状腺术后低钙血症早期预测研究进展. 中国实用外科杂志, 2016, 36(11): 1234-1237.
15.	Zhang L, Wei WJ, Ji QH, et al. Risk factors for neck nodal metastasis in papillary thyroid microcarcinoma: a study of 1 066 patients. J Clin Endocrinol Metab, 2012, 97(4): 1250-1257.
16.	Nam IC, Park JO, Joo YH, et al. Pattern and predictive factors of regional lymph node metastasis in papillary thyroid carcinoma: a prospective study. Head Neck, 2013, 35(1): 40-45.
17.	Ito Y, Miyauchi A, Kihara M, et al. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid, 2014, 24(1): 27-34.
18.	Ma B, Wang Y, Yang S, et al. Predictive factors for central lymph node metastasis in patients with cN0 papillary thyroid carcinoma: a systematic review and meta-analysis. Int J Surg, 2016, 28: 153-161.
19.	Ito Y, Fukushima M, Higashiyama T, et al. Tumor size is the strongest predictor of microscopic lymph node metastasis and lymph node recurrence of N0 papillary thyroid carcinoma. Endocr J, 2013, 60(1): 113-117.
20.	Liang K, He L, Dong W, et al. Risk factors of central lymph node metastasis in cN0 papillary thyroid carcinoma: a study of 529 patients. Med Sci Monit, 2014, 20: 807-811.
21.	Jiang LH, Chen C, Tan Z, et al. Clinical characteristics related to central lymph node metastasis in cN0 papillary thyroid carcinoma: a retrospective study of 916 patients. Int J Endocrinol, 2014, 2014: 385787.
22.	Lang BH, Chai YJ, Cowling BJ, et al. Is BRAF^V600E mutation a marker for central nodal metastasis in small papillary thyroid carcinoma? Endocr Relat Cancer, 2014, 21(2): 285-295.
23.	Xue S, Wang P, Liu J, et al. Prophylactic central lymph node dissection in cN0 patients with papillary thyroid carcinoma: A retrospective study in China. Asian J Surg, 2016, 39(3): 131-136.
24.	Kim E, Choi JY, Koo do H, et al. Differences in the characteristics of papillary thyroid microcarcinoma ≤5 mm and >5 mm in diameter. Head Neck, 2015, 37(5): 694-697.
25.	Vasileiadis I, Karakostas E, Charitoudis G, et al. Papillary thyroid microcarcinoma: clinicopathological characteristics and implications for treatment in 276 patients. Eur J Clin Invest, 2012, 42(6): 657-664.
26.	Zhang LY, Liu ZW, Liu YW, et al. Risk factors for nodal metastasis in cN0 papillary thyroid microcarcinoma. Asian Pac J Cancer Prev, 2015, 16(8): 3361-3363.
27.	Lee KJ, Cho YJ, Kim SJ, et al. Analysis of the clinicopathologic features of papillary thyroid microcarcinoma based on 7-mm tumor size. World J Surg, 2011, 35(2): 318-323.
28.	Sugitani I, Toda K, Yamada K, et al. Three distinctly different kinds of papillary thyroid microcarcinoma should be recognized: our treatment strategies and outcomes. World J Surg, 2010, 34(6): 1222-1231.
29.	Lundgren CI, Hall P, Dickman PW, et al. Clinically significant prognostic factors for differentiated thyroid carcinoma: a population-based, nested case-control study. Cancer, 2006, 106(3): 524-531.
30.	程若川. 2015 年版较 2009 年版 ATA 指南对甲状腺乳头状癌的手术治疗变化及解读. 中国普外基础与临床杂志, 2016, 23(10): 1166-1168.
31.	Park JP, Roh JL, Lee JH, et al. Risk factors for central neck lymph node metastasis of clinically noninvasive, node-negative papillary thyroid microcarcinoma. Am J Surg, 2014, 208(3): 412-418.
32.	Ji YB, Yoo HS, Song CM, et al. Predictive factors and pattern of central lymph node metastasis in unilateral papillary thyroid carcinoma. Auris Nasus Larynx, 2016, 43(1): 79-83.
33.	Viola D, Materazzi G, Valerio L, et al. Prophylactic central compartment lymph node dissection in papillary thyroid carcinoma: clinical implications derived from the first prospective randomized controlled single institution study. J Clin Endocrinol Metab, 2015, 100(4): 1316-1324.
34.	Kim BY, Jung CH, Kim JW, et al. Impact of clinicopathologic factors on subclinical central lymph node metastasis in papillary thyroid microcarcinoma. Yonsei Med J, 2012, 53(5): 924-930.
35.	Mitchell AL, Gandhi A, Scott-Coombes D, et al. Management of thyroid cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol, 2016, 130(S2): S150-S160.
36.	Xiang D, Xie L, Xu Y, et al. Papillary thyroid microcarcinomas located at the middle part of the middle third of the thyroid gland correlates with the presence of neck metastasis. Surgery, 2015, 157(3): 526-533.
37.	Wada N, Duh QY, Sugino K, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg, 2003, 237(3): 399-407.
38.	Lee YS, Shin SC, Lim YS, et al. Tumor location-dependent skip lateral cervical lymph node metastasis in papillary thyroid cancer. Head Neck, 2014, 36(6): 887-891.
39.	Liu Z, Wang L, Yi P, et al. Risk factors for central lymph node metastasis of patients with papillary thyroid microcarcinoma: a meta-analysis. Int J Clin Exp Pathol, 2014, 7(3): 932-937.
40.	彭琛, 魏松锋, 郑向前, 等. 1 401 例甲状腺微小乳头状癌临床病理特征及中央区淋巴结转移危险因素分析. 中国肿瘤临床, 2016, 43(3): 95-99.
41.	Randolph GW著; 田文, 姜可伟, 译. 甲状腺和甲状旁腺外科学. 第 2 版. 北京: 北京大学医学出版社, 2016: 49-51.
42.	Shan Z, Chen L, Lian X, et al. Iodine status and prevalence of thyroid disorders after introduction of mandatory universal salt iodization for 16 years in China: a cross-sectional study in 10 cities. Thyroid, 2016, 26(8): 1125-1130.
43.	Lee JH, Kim Y, Choi JW, et al. The association between papillary thyroid carcinoma and histologically proven Hashimoto’s thyroiditis: a meta-analysis. Eur J Endocrinol, 2013, 168(3): 343-349.
44.	Zhu Y, Zheng K, Zhang H, et al. The clinicopathologic differences of central lymph node metastasis in predicting lateral lymph node metastasis and prognosis in papillary thyroid cancer associated with or without Hashimoto's thyroiditis. Tumour Biol, 2016, 37(6): 8037-8045.
45.	Kim KW, Park YJ, Kim EH, et al. Elevated risk of papillary thyroid cancer in Korean patients with Hashimoto’s thyroiditis. Head Neck, 2011, 33(5): 691-695.
46.	Zhang L, Li H, Ji QH, et al. The clinical features of papillary thyroid cancer in Hashimoto's thyroiditis patients from an area with a high prevalence of Hashimoto’s disease. BMC Cancer, 2012, 12(1): 610-617.
47.	Liotti F, Visciano C, Melillo RM. Inflammation in thyroid oncogenesis. Am J Cancer Res, 2012, 2(3): 286-297.
48.	Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell, 2011, 144(5): 646-674.
49.	Fugazzola L, Puxeddu E, Avenia N, et al. Correlation between B-RAF^V600E mutation and clinico-pathologic parameters in papillary thyroid carcinoma: data from a multicentric Italian study and review of the literature. Endocr Relat Cancer, 2006, 13(2): 455-464.
50.	Xing M, Alzahrani AS, Carson KA, et al. Association between BRAF V600E mutation and mortality in patients with papillary thyroid cancer. JAMA, 2013, 309(14): 1493-1501.
51.	Kim TH, Park YJ, Lim JA, et al. The association of the BRAF(V600E) mutation with prognostic factors and poor clinical outcome in papillary thyroid cancer: a meta-analysis. Cancer, 2012, 118(7): 1764-1773.
52.	石臣磊, 丁超, 秦华东, 等. BRAF^V600E 突变与乳头状甲状腺癌中央区淋巴结转移的关系. 中国普通外科杂志, 2014, 23(11): 1522-1526.
53.	高庆军, 张伟, 王南鹏, 等. BRAFV600E 突变和 cN0 期甲状腺乳头状癌淋巴结转移相关性研究. 临床耳鼻咽喉头颈外科杂志, 2015, 29(23): 2048-2052.
54.	Schneider DF, Chen H. New developments in the diagnosis and treatment of thyroid cancer. CA Cancer J Clin, 2013, 63(6): 374-394.

1. WHO, IARC. International agency for research on cancer. World Cancer Report 2014. Lyon: IARC Press, 2014: 738-750.
2. Dal Maso L, Lise M, Zambon P, et al. Incidence of thyroid cancer in Italy, 1991-2005: time trends and age-period-cohort effects. Ann Oncol, 2011, 22(4): 957-963.
3. Mao LN, Wang P, Li ZY, et al. Risk factor analysis for central nodal metastasis in papillary thyroid carcinoma. Oncol Lett, 2015, 9(1): 103-107.
4. 刘文, 程若川, 苏艳军, 等. 2015 版美国甲状腺协会指南 cN0 甲状腺乳头状癌手术方案合理性分析. 中国实用外科杂志, 2017, 37(5): 568-571.
5. Amin MB, Greene FL, Edge SB, et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more " personalized” approach to cancer staging. CA Cancer J Clin, 2017, 67(2): 93-99.
6. Chéreau N, Buffet C, Trésallet C, et al. Recurrence of papillary thyroid carcinoma with lateral cervical node metastases: Predictive factors and operative management. Surgery, 2016, 159(3): 755-762.
7. 刘文, 程若川, 苏艳军, 等. 甲状腺微小乳头状癌 rⅥb 区转移预测因素及 rⅥa 区、rⅥb 区转移相关性研究. 中国实用外科杂志, 2017, 37(9): 1007-1012.
8. NCCN. The NCCN Thyroid Carcinoma Clinical Practice Guidelines in Oncology (Version 2.2017). 2017-05-17. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp.
9. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 2016, 26(1): 1-133.
10. Gharib H, Papini E, Garber JR, et al. American Association of Clinical Endocrinologists, American College of Endocrinology and Associazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules-2016 update executive summary of recommendations. Endocr Pract, 2016, 22(5): 622-639.
11. 中华医学会内分泌学分会, 中华医学会外科学分会, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南. 中国肿瘤临床, 2012, 39(17): 1249-1272.
12. Lee DW, Ji YB, Sung ES, et al. Roles of ultrasonography and computed tomography in the surgical management of cervical lymph node metastases in papillary thyroid carcinoma. Eur J Surg Oncol, 2013, 39(2): 191-196.
13. Khokhar MT, Day KM, Sangal RB, et al. Preoperative high-resolution ultrasound for the assessment of malignant central compartment lymph nodes in papillary thyroid cancer. Thyroid, 2015, 25(12): 1351-1354.
14. 刘文, 闫雪晶, 程若川, 等. 甲状腺术后低钙血症早期预测研究进展. 中国实用外科杂志, 2016, 36(11): 1234-1237.
15. Zhang L, Wei WJ, Ji QH, et al. Risk factors for neck nodal metastasis in papillary thyroid microcarcinoma: a study of 1 066 patients. J Clin Endocrinol Metab, 2012, 97(4): 1250-1257.
16. Nam IC, Park JO, Joo YH, et al. Pattern and predictive factors of regional lymph node metastasis in papillary thyroid carcinoma: a prospective study. Head Neck, 2013, 35(1): 40-45.
17. Ito Y, Miyauchi A, Kihara M, et al. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid, 2014, 24(1): 27-34.
18. Ma B, Wang Y, Yang S, et al. Predictive factors for central lymph node metastasis in patients with cN0 papillary thyroid carcinoma: a systematic review and meta-analysis. Int J Surg, 2016, 28: 153-161.
19. Ito Y, Fukushima M, Higashiyama T, et al. Tumor size is the strongest predictor of microscopic lymph node metastasis and lymph node recurrence of N0 papillary thyroid carcinoma. Endocr J, 2013, 60(1): 113-117.
20. Liang K, He L, Dong W, et al. Risk factors of central lymph node metastasis in cN0 papillary thyroid carcinoma: a study of 529 patients. Med Sci Monit, 2014, 20: 807-811.
21. Jiang LH, Chen C, Tan Z, et al. Clinical characteristics related to central lymph node metastasis in cN0 papillary thyroid carcinoma: a retrospective study of 916 patients. Int J Endocrinol, 2014, 2014: 385787.
22. Lang BH, Chai YJ, Cowling BJ, et al. Is BRAF^V600E mutation a marker for central nodal metastasis in small papillary thyroid carcinoma? Endocr Relat Cancer, 2014, 21(2): 285-295.
23. Xue S, Wang P, Liu J, et al. Prophylactic central lymph node dissection in cN0 patients with papillary thyroid carcinoma: A retrospective study in China. Asian J Surg, 2016, 39(3): 131-136.
24. Kim E, Choi JY, Koo do H, et al. Differences in the characteristics of papillary thyroid microcarcinoma ≤5 mm and >5 mm in diameter. Head Neck, 2015, 37(5): 694-697.
25. Vasileiadis I, Karakostas E, Charitoudis G, et al. Papillary thyroid microcarcinoma: clinicopathological characteristics and implications for treatment in 276 patients. Eur J Clin Invest, 2012, 42(6): 657-664.
26. Zhang LY, Liu ZW, Liu YW, et al. Risk factors for nodal metastasis in cN0 papillary thyroid microcarcinoma. Asian Pac J Cancer Prev, 2015, 16(8): 3361-3363.
27. Lee KJ, Cho YJ, Kim SJ, et al. Analysis of the clinicopathologic features of papillary thyroid microcarcinoma based on 7-mm tumor size. World J Surg, 2011, 35(2): 318-323.
28. Sugitani I, Toda K, Yamada K, et al. Three distinctly different kinds of papillary thyroid microcarcinoma should be recognized: our treatment strategies and outcomes. World J Surg, 2010, 34(6): 1222-1231.
29. Lundgren CI, Hall P, Dickman PW, et al. Clinically significant prognostic factors for differentiated thyroid carcinoma: a population-based, nested case-control study. Cancer, 2006, 106(3): 524-531.
30. 程若川. 2015 年版较 2009 年版 ATA 指南对甲状腺乳头状癌的手术治疗变化及解读. 中国普外基础与临床杂志, 2016, 23(10): 1166-1168.
31. Park JP, Roh JL, Lee JH, et al. Risk factors for central neck lymph node metastasis of clinically noninvasive, node-negative papillary thyroid microcarcinoma. Am J Surg, 2014, 208(3): 412-418.
32. Ji YB, Yoo HS, Song CM, et al. Predictive factors and pattern of central lymph node metastasis in unilateral papillary thyroid carcinoma. Auris Nasus Larynx, 2016, 43(1): 79-83.
33. Viola D, Materazzi G, Valerio L, et al. Prophylactic central compartment lymph node dissection in papillary thyroid carcinoma: clinical implications derived from the first prospective randomized controlled single institution study. J Clin Endocrinol Metab, 2015, 100(4): 1316-1324.
34. Kim BY, Jung CH, Kim JW, et al. Impact of clinicopathologic factors on subclinical central lymph node metastasis in papillary thyroid microcarcinoma. Yonsei Med J, 2012, 53(5): 924-930.
35. Mitchell AL, Gandhi A, Scott-Coombes D, et al. Management of thyroid cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol, 2016, 130(S2): S150-S160.
36. Xiang D, Xie L, Xu Y, et al. Papillary thyroid microcarcinomas located at the middle part of the middle third of the thyroid gland correlates with the presence of neck metastasis. Surgery, 2015, 157(3): 526-533.
37. Wada N, Duh QY, Sugino K, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg, 2003, 237(3): 399-407.
38. Lee YS, Shin SC, Lim YS, et al. Tumor location-dependent skip lateral cervical lymph node metastasis in papillary thyroid cancer. Head Neck, 2014, 36(6): 887-891.
39. Liu Z, Wang L, Yi P, et al. Risk factors for central lymph node metastasis of patients with papillary thyroid microcarcinoma: a meta-analysis. Int J Clin Exp Pathol, 2014, 7(3): 932-937.
40. 彭琛, 魏松锋, 郑向前, 等. 1 401 例甲状腺微小乳头状癌临床病理特征及中央区淋巴结转移危险因素分析. 中国肿瘤临床, 2016, 43(3): 95-99.
41. Randolph GW著; 田文, 姜可伟, 译. 甲状腺和甲状旁腺外科学. 第 2 版. 北京: 北京大学医学出版社, 2016: 49-51.
42. Shan Z, Chen L, Lian X, et al. Iodine status and prevalence of thyroid disorders after introduction of mandatory universal salt iodization for 16 years in China: a cross-sectional study in 10 cities. Thyroid, 2016, 26(8): 1125-1130.
43. Lee JH, Kim Y, Choi JW, et al. The association between papillary thyroid carcinoma and histologically proven Hashimoto’s thyroiditis: a meta-analysis. Eur J Endocrinol, 2013, 168(3): 343-349.
44. Zhu Y, Zheng K, Zhang H, et al. The clinicopathologic differences of central lymph node metastasis in predicting lateral lymph node metastasis and prognosis in papillary thyroid cancer associated with or without Hashimoto's thyroiditis. Tumour Biol, 2016, 37(6): 8037-8045.
45. Kim KW, Park YJ, Kim EH, et al. Elevated risk of papillary thyroid cancer in Korean patients with Hashimoto’s thyroiditis. Head Neck, 2011, 33(5): 691-695.
46. Zhang L, Li H, Ji QH, et al. The clinical features of papillary thyroid cancer in Hashimoto's thyroiditis patients from an area with a high prevalence of Hashimoto’s disease. BMC Cancer, 2012, 12(1): 610-617.
47. Liotti F, Visciano C, Melillo RM. Inflammation in thyroid oncogenesis. Am J Cancer Res, 2012, 2(3): 286-297.
48. Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell, 2011, 144(5): 646-674.
49. Fugazzola L, Puxeddu E, Avenia N, et al. Correlation between B-RAF^V600E mutation and clinico-pathologic parameters in papillary thyroid carcinoma: data from a multicentric Italian study and review of the literature. Endocr Relat Cancer, 2006, 13(2): 455-464.
50. Xing M, Alzahrani AS, Carson KA, et al. Association between BRAF V600E mutation and mortality in patients with papillary thyroid cancer. JAMA, 2013, 309(14): 1493-1501.
51. Kim TH, Park YJ, Lim JA, et al. The association of the BRAF(V600E) mutation with prognostic factors and poor clinical outcome in papillary thyroid cancer: a meta-analysis. Cancer, 2012, 118(7): 1764-1773.
52. 石臣磊, 丁超, 秦华东, 等. BRAF^V600E 突变与乳头状甲状腺癌中央区淋巴结转移的关系. 中国普通外科杂志, 2014, 23(11): 1522-1526.
53. 高庆军, 张伟, 王南鹏, 等. BRAFV600E 突变和 cN0 期甲状腺乳头状癌淋巴结转移相关性研究. 临床耳鼻咽喉头颈外科杂志, 2015, 29(23): 2048-2052.
54. Schneider DF, Chen H. New developments in the diagnosis and treatment of thyroid cancer. CA Cancer J Clin, 2013, 63(6): 374-394.

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Predictors of central lymph node metastasis in papillary thyroid carcinoma

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