Video-Assisted Lateral Neck Dissection Has Good Efficacy and Safety: A Long-Term Follow-Up Study.

The purpose of this study was to investigate the risk factors for central and lateral neck lymph node metastases in papillary thyroid carcinoma (PTC) and multifocal papillary thyroid carcinoma (MPTC), particularly when associated with Hashimoto thyroiditis (HT).A retrospective analysis of 763 consecutive patients who underwent total thyroidectomy with bilateral central neck dissection in the First Affiliated Hospital, College of Medicine, Zhejiang University between October 2011 and October 2014 was conducted. All patients had formal histological diagnoses of HT. Multivariable logistic regression analysis was performed to identify risk factors of neck lymph node metastases.Our study identified 277 PTC patients with HT and showed comparatively low rates of central lymph node metastases (CLNM) compared with the PTC patients without HT (37.2% versus 54.7%, P < 0.001). There were no statistically significant differences in lateral lymph node metastases (LLNM) (P = 0.656). Neck lymph node metastases were histologically proven in 127 (45.8%) patients with PTC with HT, including 103 CLNM and 24 LLNM. There were no significant differences in LLNM between the MPTC-associated HT and classic MPTC cases; however, a significantly reduced risk of CLNM was observed in the MPTC-associated HT compared with the MPTC cases (35.7% versus 72.4%, respectively, P < 0.001). In the multivariate analysis, HT was identified as an independent alleviating factor for CLNM in all PTC patients (odds ratio, 0.369; 95% confidence interval (CI), 0.261 to 0.521; P < 0.001) and in MPTC patients (odds ratio, 0.227; 95% CI, 0.126–0.406; P < 0.001). A cut-off of thyroid peroxidase antibody >140 IU/mL was established as the most sensitive and specific level for the prediction of MPTC based on receiver operating characteristic curve analyses. Thyroid peroxidase antibody, age, tumor size, and multifocality exhibited the ability to predict CLNM in PTC with HT patients with an area under the curve of 81.1% based on a multivariate model.Hashimoto thyroiditis was associated with increased prevalences of multifocality and capsular invasion. In contrast, HT was associated with a reduced risk of CLNM in PTC and MPTC patients, which indicated a potential protective effect. We found that the prognostic prediction model was applicable for predicting multifocality and CLNM in PTC patients with HT.

Papillary thyroid cancer (PTC) metastasizes to central lymph node (CLN). CLN metastasis is associated with high risk of locoregional recurrence and distant metastasis. The significance of the number of metastatic CLN has not been addressed. This study was designed to evaluate the clinical implication of the number of metastatic CLN in PTC. We reviewed the patients who underwent total thyroidectomy and CLN dissection with or without lateral neck dissection due to PTC, from March 2008 to June 2009. The relationships between the number of CLN and risk factors, including age, gender, tumor size, extrathyroidal extension, and lateral lymph node metastasis, were assessed. Patients were divided into three groups according to the number of CLN: group A=0; group B=1-2; and group C=≥3. Of 258 patients enrolled in this study, 113 were in group A, 73 in group B, and 72 in group C. Extrathyroidal extension and lateral neck lymph node metastasis were related to increased rate of CLN metastasis (P<0.05). Tumor size increased as the number of CLN increased; group C had the largest tumor size (P<0.05). When evaluating the distribution of patients with extrathyroidal extension, group C had a significant odds ratio (4.213, P<0.05). When evaluating the distribution of lateral neck lymph node metastasis, groups B and C had significant odds ratio (14.353, 75.403, respectively, P<0.05). The number of CLN metastasis correlated with the negative prognostic factors, including tumor size, extrathyroidal extension, and lateral neck lymph node metastasis. This suggests that the number of CLN has prognostic implication.

Background:The 2015 American Thyroid Association guidelines recommend total thyroidectomy (TT) followed by radioactive iodine (RAI) therapy as the primary treatment modality for intermediate-risk papillary thyroid carcinoma (PTC) patients with lateral lymph node metastasis (LLNM). However, the supporting evidence remains insufficient. The clinical superiority of TT versus lobectomy (LT) in this patient population remains unclear, and the optimal surgical approach for intermediate-risk PTC with LLNM continues to be debated.Aim:This meta-analysis examined the clinical superiority of TT versus LT for intermediate-risk PTC with unilateral LLNM.Methods:This PRISMA/AMSTAR-compliant meta-analysis (PROSPERO: CRD42023410775) evaluated recurrence-free survival (RFS) in intermediate-risk PTC with unilateral LLNM. Systematic searches of PubMed, Web of Science, and Cochrane Library (2004–2024) combined Medical Subject Heading terms and title/abstract: (“papillary thyroid carcinoma” OR “papillary thyroid cancer” OR “PTC”) AND (“lateral cervical lymph node metastasis” OR “lateral neck lymph node metastasis” OR “lateral lymph node metastasis” OR “lateral cervical nodal metastasis” OR “N1b”) AND (“thyroidectomy” OR “total thyroidectomy” OR “lobectomy”). Two investigators independently extracted data on surgical outcomes, adjuvant RAI therapy, and RFS metrics, with quality assessed via Newcastle–Ottawa Scale. Prespecified subgroup analyses examined RAI utilization and surgical extent impacts. Pooled hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Review Manager 5.3, prioritizing adjusted HR. Heterogeneity was assessed via I2 statistics.Results:Among 609 initially identified references, 8 studies met the inclusion and exclusion criteria, comprising 2462 intermediate-risk PTC patients with unilateral LLNM. Of these, 53.3% (1313/2462) underwent TT, and 46.7% (1149/2462) underwent LT. Compared with the TT group, LT showed no statistically significant difference on RFS (HR = 1.08, 95% CI 0.83–1.40, P = 0.56). In subgroup analyses: Compared with TT + RAI, LT showed no significant difference in RFS (HR = 0.66, 95% CI 0.40–1.08, P = 0.10); Compared with TT + RAI, LT or TT alone showed no significant difference in RFS (HR = 0.65, 95% CI 0.41–1.03, P = 0.07); Compared with TT alone, LT showed no significant difference in RFS (HR = 1.16, 95% CI 0.63–2.12, P = 0.64); Compared with TT + RAI, TT alone showed no significant difference in RFS (HR = 0.87, 95% CI 0.42–1.81, P = 0.37).Conclusion:For intermediate-risk PTC patients with isolated unilateral LLNM, TT, and LT demonstrate comparable oncological outcomes in terms of RFS. Unilateral LLNM alone should not constitute an absolute indication for TT. When no additional high-risk features are present, LT may serve as a preferable alternative to optimize quality of life while maintaining oncological safety.

To develop a tumor burden score (TBS)-based risk stratification system (RSS) for preoperative discrimination of lateral lymph node metastasis (LLNM) and compare it with conventional US and TBS-only models. This retrospective study included consecutive 404 adult patients diagnosed with PTC who underwent thyroid US and lateral lymph node dissection between January 2021 and October 2023. A prospective validation cohort was established with 174 patients enrolled from November 2023 to August 2024. Two novel tumor burden parameters, including D1/D2 and TBS score, were proposed. Logistic regression analyses were performed to assess associations between variables and LLNM in the training cohort. Features with p < 0.05 were incorporated into the LLNM RSS based on the Framingham risk score equation. Area under the receiver operating characteristic curve (AUC) was compared among the RSS, conventional US model, and TBS model in both cohorts. In both training and validation cohorts, the RSS showed improved performance for identifying LLNM compared with the TBS model (AUC, 0.809 vs. 0.703, p < 0.01 and AUC, 0.752 vs. 0.634, p = 0.03), and in the training cohort, the AUC of the RSS was superior compared with the conventional US model (AUC, 0.809 vs. 0.732, p < 0.01). Furthermore, we identified clustered punctate echogenic foci (PEF) distributed along the periphery of primary tumors as a robust independent predictor of LLNM (OR = 3.157, 95% CI: 1.520-6.557). The user-friendly RSS constructed based on the tumor burden concept outperformed conventional US and TBS models for distinguishing LLNM in PTC preoperatively. Question To develop a risk stratification system (RSS) for the prediction of lateral lymph node metastasis (LLNM) in papillary thyroid carcinoma (PTC), addressing the limitations of first-line ultrasound. Findings The tumor burden-based RSS achieved superior accuracy (AUC = 0.81) versus the conventional ultrasound-based model (AUC = 0.70), effectively evaluating the risk of LLNM preoperatively. Clinical relevance The RSS incorporating tumor burden parameters and peripheral punctate echogenic foci sign demonstrates strong predictive value for LLNM and enables risk-stratified surgical planning, avoiding unnecessary lymph node dissection in low-risk PTC while identifying occult metastases in high-risk cases.

Although safe in patients with papillary thyroid carcinoma (PTC), robotic thyroidectomy using a bilateral axillo-breast approach (BABA) has not been frequently performed in patients with advanced PTC. This study describes surgical outcomes in patients with PTC and lymph node metastasis (LNM) in lateral neck compartment who underwent robotic-assisted modified radical neck dissection with BABA (robotic BABA MRND). The medical records of patients with PTC and lateral LNM who underwent robotic BABA MRND from March 2010 to July 2016 were retrospectively reviewed. Fifteen patients, 14 women and 1 man, of mean age 37.1 ± 9.3 years, were enrolled. Mean operation time was 272.7 ± 33.8min. A mean 20.7 ± 7.2 lymph nodes were retrieved from the lateral neck compartment, with a mean 5.3 ± 4.4 lymph nodes being metastatic. The rates of transient and permanent hypocalcemia were 46.7 and 0%, respectively, and the rates of transient and permanent vocal cord palsy were 6.7 and 0%, respectively. Fourteen patients (93.3%) had stimulated thyroglobulin concentrations below 2ng/mL after the first treatment with radioactive iodine. Robotic BABA MRND could be safely performed and may be a good surgical option in selected patients with PTC and lateral LNM.

Whether the lymph node posterior to the right recurrent laryngeal nerve (LN-prRLN) should be dissected is still controversial. This meta-analysis aimed to assess the risk factors for LN-prRLN metastasis in papillary thyroid carcinoma (PTC). We retrieved relevant studies published before May 2020 from the Wanfang Data, CNKI, PubMed, Embase, Web of Science and Cochrane Library databases. Heterogeneity was assessed with the Q-test and inconsistency index and sensitivity analysis and subgroup analysis were then used to find the source of heterogeneity. Begg test and generate a funnel chart to assess publication bias. We retrieved 236 articles, 14 articles were selected as the subjects of our research. Fourteen studies involving 10,580 patients were analysed in this study. The LN-prRLN metastasis rate was 9.22% (975/10,580). The results of the meta-analysis showed that sex (P<0.001), age (P<0.001), tumour size (P<0.001), multifocality (P<0.001), capsular invasion (P=0.04), extrathyroidal extension (P<0.001), superficial central lymph node (VIa-LN) metastasis (P<0.001), and lateral lymph node (LLN) metastasis (P<0.001) were correlated with LN-prRLN metastasis. Male sex, age ≤45 years, tumour size >1 cm, multifocality, capsular invasion or extrathyroidal extension, and VIa-LN metastasis or LLN metastasis in PTC patients were significant risk factors for predicting LN-prRLN metastasis. B ultrasound and CT scans are expected to predict LN-prRLN metastasis in the future. This research is registered on the PROSPERO website (registration number: CRD42020200898).

The optimal extent of therapeutic lateral neck dissection (ND) in papillary thyroid carcinoma (PTC) continues to be debated. We analyzed the frequency, patterns, and predictive factors of occult level Va and Vb metastasis in clinically lateral node-positive PTC patients. We reviewed the data of PTC patients who underwent thyroidectomy and therapeutic lateral ND from level II to V between May 2008 and August 2020. In our study, 46 patients without clinically positive metastatic lymph nodes (LNs) at level V on the preoperative evaluation were included to analyze occult metastasis at level Va and Vb, respectively. Patient demographics, including age, sex, distribution of pathologic LNs, and characteristics of the primary tumors, were reviewed. In addition, clinicopathologic factors associated with occult level Va and Vb metastasis were analyzed. Of the 46 patients, 14 (30.4%) patients had occult metastases at level Vb. No occult metastases were found at level Va. Clinically positive level II metastasis (p = 0.015) and simultaneous level II, III, and IV metastases (p = 0.010) in the preoperative evaluation were significantly associated with occult level Vb metastasis. Patients without LN metastasis at level IV or with three or fewer metastatic LNs in the lateral neck never had occult LN metastases at level Vb. Occult metastasis at level Va is rare in PTC with lateral LN metastasis. Occult metastasis at level Vb may occur in PTC patients with multilevel involvement, including level II and/or four or more lateral LN metastases.

To analyse the clinical features and treatment strategies of papillary thyroid carcinoma(PTC) coexistent with lymphocytic thyroiditis (LT). A total of 292 patients including 25 males and 267 females with LT and thyroid nodules treated in the department of head and neck surgery between Sep 2011 and Sep 2014 was analysed retrospectively and divided into two groups according to pathological results, of them 262 patients, with a median age of 47 years old, were LT with PTC and 30 patients, with a median age of 54 years old, were LT with benign nodules. Among 262 patients having LT with PTC, 259 were diagnosed as having malignant or suspicious malignant nodules and 3 having benign nodules with ultrasound before surgery, 98 cases were considered multifocal malignant nodules by preoperative ultrasound, and 112 cases were positive in cervical lymph nodes, including bilateral positive in 37 cases. Of 30 patients having LT with benign nodules, 14 were diagnosed malignant or suspicious malignant nodules and 16 benign nodules. The mean age in 262 patients with PTC was less significantly than that in 30 patients with benign nodules (P<0.05). Ultrasound showed a high proportion of calcification and microcalcification in patients with PTC (34%) compared to patients with benign nodules(13%)(P<0.05). There were not significant differences in the mean levels of serum thyroid stimulating hormone(TSH) (2.80 vs 2.99 mU/L, P=0.233), thyroglobulin(TG) (27.14 vs 18.60 μg/L, P=0.747), and anti-thyroglobulin antibodies(ATG)(417.3 vs 378.7 U/ml, P=0.834) between patients with PTC and those with benign nodules. In patients with PTC, multifocal tumor accounted for 42%. The central and lateral lymph node metastasis rates were respectively 50% and 24%, and the occult metastasis rate of lateral neck lymph node was 16%. Univariate analysis showed that age less than 45 years old, multifocal tumor, tumor diameter more than or equal to 2cm and extrathyroidal extension were associated with central lymph node metastasis (P<0.05), but not with lateral neck metastasis. Multivariate analysis showed a closed correlation only between the lymph node metastases in central and lateral neck levels (P<0.05). Calcification and microcalcification have the same importance in the ultrasonic diagnosis for PTC in patients with LT. Total thyroidectomy and prophylactic central lymph node should be a choice for LT with PTC. Lymph node metastasis in level Ⅵ indicates the possibility of lateral cervical lymph node metastasis in the patients having LT with PTC.

Currently, there is a lack of evidence-based risk factors for the lateral cervical lymph node metastasis of papillary thyroid carcinoma (PTC). Thus, the risk factors and recurrence rate of lateral cervical lymph node metastasis were investigated in the present study for patients with PTC who underwent initial radical surgery. The data of 274 patients with PTC who underwent initial radical surgery over a 10-year period from January, 2009 to December, 2018 were retrospectively analyzed. By applying univariate analysis, lymphovascular invasion, venous invasion, extrathyroidal infiltration, paratracheal lymph node metastasis and tumor size were designated as significant risk factors for lateral cervical lymph node metastasis. As regards multivariate analysis, paratracheal lymph node metastasis and tumor size were identified as independent risk factors. The recurrence rate was higher in patients presenting with lateral cervical lymph node metastasis, and the disease-free survival rate was significantly lower in the patient group presenting with lateral cervical lymph node metastasis. On the whole, the present study demonstrated that paratracheal lymph node metastasis and tumor size were independent risk factors for lateral cervical lymph node metastasis.

Objective: To explore the potential value of a novel marker, KIF-12, in the progression and prognosis of papillary thyroid carcinoma (PTC) through integrative bioinformatics analysis, and clinical sample validation of the prognostic value of KIF-12. Materials and Methods: We extracted the clinicopathological data of 502 PTC patients from The Cancer Genome Atlas-Thyroid Cancer (TCGA-THCA) dataset to identify reliable differentially expressed genes (DEGs) between high and low KIF12 expression groups. Functional enrichment analysis was performed on upregulated DEGs. Gene set enrichment analysis (GESA) was performed to identify the biological pathways. We further applied Cox analysis to determine independent risk factors associated with the PTC progression-free interval (PFI), and a nomogram was established to predict disease outcome. Finally, the prognostic value of KIF12 was validated by means of clinical samples from PTC patients with and without lateral lymph node metastasis. Results: On the basis of the TCGA-THCA database, we found that low KIF-12 expression was significantly related to a higher TNM stage (p<0.05), BRAF mutation status (p = 0.019), and extrathyroidal extension (p<0.001). KIF-12 was an independent prognostic factor of PTC (OR=0.319, 95% CI=0.130-0.784, P=0.013). The prognostic value of KIF12 was also successfully validated in clinical samples from twenty-nine PTC patients with lateral lymph node metastasis by comparison with twenty-two PTC patients without lymph node metastasis (P = 0.004). Conclusions: We report that KIF-12 has a tumor suppressive function in PTC and may be a useful prognostic tool to predict patient outcomes.

The management of papillary thyroid carcinoma (PTC), particularly in cases with clinically apparent lateral neck lymph node metastasis (cN1b), remains an area of debate. The surgical options for PTC, including total thyroidectomy and lobectomy, have distinct impacts on patients' outcomes and quality of life. To compare survival and recurrence outcomes between patients who underwent a lobectomy plus ipsilateral lateral neck dissection (LND) and those who underwent a total thyroidectomy plus ipsilateral LND for intermediate-risk cN1b PTC with both primary tumors and lymph node metastases in the ipsilateral neck region. This retrospective cohort study was conducted at Ito Hospital, Tokyo, Japan. Patients who underwent surgery for PTC between January 2005 and December 2012 were included, and those with high-risk PTCs and concurrent other thyroid cancers were excluded. Data were analyzed from April to August 2024. Lobectomy plus LND vs total thyroidectomy plus LND. An inverse probability of treatment weighting (IPTW)-adjusted Kaplan-Meier analysis and a Cox proportional hazards regression analysis were performed to compare the patients' overall survival, recurrence-free survival (RFS), and modified RFS (which considered the potential need for a future contralateral lobectomy). Of 401 included patients, 317 (79.1%) were female, and the median (IQR) age was 47 (36-59) years. A total of 157 patients underwent lobectomy plus ipsilateral LND and 244 underwent total thyroidectomy plus ipsilateral LND. The median (IQR) follow-up time was 13.0 (11.2-15.0) years. The IPTW-adjusted overall survival rates at 5, 10, and 15 years were 98.0% (95% CI, 93.9-99.3), 97.5% (95% CI, 93.2-99.1), and 96.8% (95% CI, 92.2-98.7), respectively, for the lobectomy group vs 99.4% (95% CI, 97.0-99.9), 97.4% (95% CI, 94.4-98.8), and 96.9% (95% CI, 93.3-98.5), respectively, for the total thyroidectomy group (hazard ratio [HR], 1.10; 95% CI, 0.35-3.47). The IPTW-adjusted RFS rates at 5, 10, and 15 years were 93.8% (95% CI, 88.5-96.7), 88.4% (95% CI, 82.0-92.6), and 84.1% (95% CI, 76.8-89.3), respectively, for the lobectomy group vs 95.4% (95% CI, 91.8-97.4), 92.9% (95% CI, 88.8-95.5), and 87.8% (95% CI, 80.8-92.4), respectively, for the total thyroidectomy group (HR, 1.41; 95% CI, 0.79-2.54). The IPTW-adjusted modified RFS rates at 5, 10, and 15 years were 96.7% (95% CI, 92.2-98.6), 93.8% (95% CI, 88.5-96.7), and 88.9% (95% CI, 82.4-93.1), respectively, for the lobectomy group vs 95.4% (95% CI, 91.8-97.4), 92.9% (95% CI, 88.8-95.5), and 87.8% (95% CI, 80.8-92.4), respectively, for the total thyroidectomy group (HR, 0.93; 95% CI, 0.49-1.76). In this study, for these selected intermediate-risk cN1b PTC cases, total thyroidectomy and lobectomy provided comparable outcomes in terms of prognosis and recurrence. These data may help inform future guideline revisions and support joint decision-making between patients and their clinicians.

Objective: To investigate the predictive factors for lateral lymph node metastasis (LLNM) in patients with papillary thyroid carcinoma (PTC) and to develop an individualized prediction model.Methods: Clinical data from 241 PTC patients who underwent lateral neck dissection were analyzed. Logistic regression and machine learning methods were employed to identify predictive factors and construct a model. The predictive value of three-dimensional morphological parameters (total tumor surface area and total tumor volume) was also evaluated.Results: Maximum tumor diameter, central lymph node metastasis, preoperative Thyroid-Stimulating Hormone (TSH), and tumor location were identified as independent predictors of LLNM. A baseline combined model based on maximum tumor diameter showed good predictive performance (AUC 0.832). Furthermore, three-dimensional parameters (total surface area and total volume) demonstrated complementary predictive potential compared to the baseline model.Conclusion: An effective clinical prediction model for assessing LLNM risk was successfully developed. Three-dimensional morphological parameters represent promising predictive indicators with potential complementary value.

PurposeComplete lymph node dissection is essential for the management of papillary thyroid carcinoma (PTC) with lymph node metastasis (LNM). This work aimed to describe the feasibility of endoscopic lateral neck dissection via the breast and transoral approach (ELNDBTOA) in PTC patients and the necessity of the addition of the transoral approach.MethodsWe included 13 patients with PTC and suspected lateral LNM who underwent ELNDBTOA at the Zhongshan Hospital, Xiamen University. Total thyroidectomy, ipsilateral central lymph node dissection, and selective neck dissection (levels IIA, IIB, III, and IV) were performed endoscopically via the breast approach. Residual lymph nodes were further dissected via the transoral approach.ResultsThe mean operation time was 362.1 ± 73.5 min. In the lateral neck compartments, the mean number of retrieved lymph nodes was 36.6 ± 23.8, and the mean number of positive lymph nodes was 6.8 ± 4.7. In further dissection via the transoral approach, lymph nodes in the lateral neck compartment were obtained in nine patients (9/13, 69.2%), and three patients (3/13, 23.1%) had confirmed lateral neck metastases. Transient hypocalcemia occurred in two patients (2/13, 15.4%), and three patients (3/13, 23.1%) developed transient skin numbness in the mandibular area. No other major complications were observed. There was no evidence of local recurrence or distant metastasis during the follow-up period (range, 24–87 months). All patients were satisfied with the good cosmetic outcome.ConclusionELNDBTOA is an option with proven feasibility for select PTC patients with LNM, and the addition of the transoral approach is necessary to ensure complete dissection.

The majority of patients with papillary thyroid carcinoma (PTC) have an excellent prognosis, but some show poorer outcomes and would benefit from adjunctive prognostic tools. The B-Raf proto-oncogene, serine/threonine kinase (BRAF)V600E mutation, either based on both its presence or its quantitative measurement, and ultrasound (US) features may serve as a prognostic marker. The aim of this study was to investigate (1) the association between clinical-pathologic prognostic factors and the BRAFV600E mutation found in fine-needle aspirates, based on both its presence and its corresponding cycle threshold (Ct) value, and (2) the association between prognostic factors and suspicious US features classified by the thyroid imaging reporting and data system (TIRADS) in PTC.Two-hundred fifty-eight consecutive patients with PTC > 1 cm and who underwent preoperative US-guided fine-needle aspiration were included in this retrospective study. Clinical-pathologic variables were compared between patients with and without the BRAFV600E mutation. Multivariate analyses were performed to investigate (1) the association between clinical-pathologic prognostic factors and the BRAF V600Emutation found in fine-needle aspirates, based on both its presence and corresponding Ct values, and (2) the association between prognostic factors and suspicious TIRADS US features.BRAFV600E-positive patients had a higher proportion of multiple tumors (P = 0.017). The number of suspicious US features classified by the TIRADS was an independent factor for predicting lateral lymph node metastasis, both in all 258 patients (odds ratio [OR] = 1.902, P = 0.005) and in 214 BRAFV600E-positive patients (OR = 1.686, P = 0.037). The BRAFV600E mutation status or BRAFV600ECt values were not associated with any of the clinical-pathologic prognostic factors.In conclusion, a higher number of suspicious US features classified by the TIRADS, but not the BRAFV600E mutation, are associated with lateral lymph node metastasis in patients with PTC, and can aid in the preoperative identification of patients at increased risk of lateral lymph node metastasis.

The central lymph node is the most common involvement for papillary thyroid carcinoma (PTC), which is correlated to recurrence and survival. But it is difficult to accurately evaluate lymph node prior to an operation. This retrospective study was designed to develop a risk model and risk stratification to preoperatively predict central lymph node metastasis (CLNM) in PTC and validate this model. A series of 1,714 initial treatment PTC patients were enrolled. Among these patients, 1,001 patients were used to develop a predictive model and establish a stratification scoring system. This was validated through the remaining 713 patients. The multivariate analysis revealed that CLNM and lateral lymph node metastasis (LLNM) in ultrasound (US), tumor size, gender, capsule invasion in US, microcalcification and age were significant independent predictors for CLNM. The area under the curve (AUC) of the model was 0.778. Furthermore, the cutoff value to predict CLNM was 8 points, and the sensitivity and specificity were 77% and 65%, respectively. In the scoring system for CLNM, a score of ≤8, 8-18 and >18 were defined as low, intermediate and high risk, respectively. The risk of CLNM was approximately 30%, 60% and 80%, corresponding to the stratification. When validated, the model predicted the risk of CLNM with an AUC of 0.811, a sensitivity and specificity of 83% and 63%, respectively. This study presented a predictive model to preoperatively assess the risk of CLNM in PTC. The predictive model performed well, but needed to be prospectively validated in external center.