Browsing by Author "Calapkulu, Murat"

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Clinicopathological Predictors of Central Lymph Node Metastasis in Clinically Node-Negative Papillary Thyroid Carcinoma: A Retrospective Cohort Analysis
(Springer, 2025) Sakiz, Davut; Calapkulu, Murat; Sencar, Muhammed Erkam; Unsal, Ilknur Ozturk; Kartal, Mehmet Zabit; Ucan, Bekir; Cakal, Erman
PurposeThis retrospective cohort study aimed to identify clinicopathological predictors of central lymph node metastasis (CLNM) in patients with papillary thyroid carcinoma (PTC).MethodsA total of 503 patients with PTC who underwent thyroidectomy with central lymph node dissection were included. Preoperative clinical data, ultrasonographic features, and postoperative histopathological characteristics were analyzed.ResultsCLNM was detected in 209 (41.55%) patients. Male sex (odds ratio [OR] = 3.12, 95% CI: 1.82-5.35), irregular nodule borders (OR = 2.02, 95% CI: 1.25-3.26) and higher risk categories in the American Thyroid Association (ATA) ultrasonographic pattern stratification system (OR = 13.312, 95% CI: 8.623-20.551) were identified as independent preoperative predictors of CLNM. A simplified model incorporating only the ATA ultrasonographic pattern stratification system and male sex achieved 83.5% accuracy in predicting CLNM. Histopathological evaluation revealed lymphovascular invasion (OR = 4.61, 95% CI: 2.81-7.55), extrathyroidal extension (OR = 2.41, 95% CI: 1.52-3.83), and multifocality (OR = 1.58, 95% CI: 1.04-2.40) as independent predictors of CLNM, while lymphocytic thyroiditis (OR = 0.59, 95% CI: 0.39-0.89) was a protective factor.ConclusionThis study establishes that ATA ultrasonographic suspicion patterns combined with the male sex provide an accurate and simplified model for preoperative CLNM prediction in PTC, outperforming complex nomograms. Key independent predictors included male sex, irregular nodule margins, ATA high-risk patterns, lymphovascular invasion, extrathyroidal extension, and multifocality, while lymphocytic thyroiditis was protective. According to the current study, risk assessment and personalized management should favor a holistic approach, rather than focusing solely on individual risk factors.
Malignancy in Toxic Thyroid Adenoma: Revisiting Risk Assessment and Identifying Predictors
(Springer, 2026) Calapkulu, Murat; Cayir, Derya; Sencar, Muhammed Erkam; Cakal, Erman; Sakiz, Davut; Unsal, Ilknur Ozturk; Tekinyildiz, Merve
Background Toxic adenomas have traditionally been considered benign due to chronic TSH suppression, which is believed to inhibit thyroid tumorigenesis. However, emerging data challenge this dogma, reporting non-negligible malignancy rates even in toxic adenoma. This study aimed to assess thyroid cancer frequency and characteristics in surgically selected patients with toxic adenomas and to compare outcomes with propensity score-matched, surgically treated non-functioning nodules. Methods This retrospective, cross-sectional study included 204 surgically treated patients at a tertiary referral center, comprising 102 surgically selected toxic adenomas and 102 propensity score-matched, surgically treated non-functioning nodules. Clinical, biochemical, sonographic, scintigraphic, and histopathological data were analyzed. Multivariate logistic regression analysis was used to identify independent predictors of malignancy among toxic adenomas. Results In this surgically selected cohort, the malignancy rate was 16.7% for toxic adenomas and 40.2% for non-functioning nodules (p < 0.001). Papillary thyroid carcinoma comprised 82.4% of all cases, making it the leading histotype (82.4%). Among toxic nodules, higher fT4/fT3 ratio (cut-off:2.58, sensitivity:93.3%, specificity:54.2%) and European Thyroid Imaging and Reporting Data System categories 4-5 were independent predictors of malignancy. No significant differences were found between groups in terms of tumor size, invasion, American Thyroid Association risk stratification, or 5-year response rates. Conclusion Among surgically treated patients, the observed malignancy rate in toxic adenomas appears to be higher than traditionally expected. Elevated fT4/fT3 ratio and suspicious ultrasound features warrant closer evaluation. These findings support using ultrasound and biochemical markers in risk assessment of all thyroid nodules, regardless of functional status.