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Article 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, ErmanPurposeThis 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.Article Diagnostic Value of Thyroid Physical Examination in the Elderly and Comparison with Ultrasonography(UK Scientific Publishing Ltd, 2025) Gulmez, Mehmet Ihsan; Aydin, CansetThis study is part of the health project called "Health screening for the elderly in Ankara" for patients aged 65 and over, with 1200 participants. Patients with missing laboratory tests (n = 59), movement disorders and/or bedridden (n = 54) were excluded from the study. PE was performed by a geriatrician or an ear, nose, and throat surgeon, and ultrasonographic evaluation was performed by a radiologist. PE and USG findings were compared. We aimed to investigate the diagnostic accuracy of physical examination (PE) of the thyroid gland (TG) in patients over 65 years of age and to assess the reliability by comparing PE with ultrasonographic (USG) examination. The median age of the patients participating in the study was 71.17. When the differences between thyroid nodules (TN), the number of TN size, and goiter detection were compared in terms of PE and USG, all values were statistically signifi- cant, and P values were < 0.001. The sensitivity of PE of TG was calculated as 31.0%. In our study, the sensitivity of PE of TG in terms of TN and goiter was found to below. The diagnostic accuracy of PE of TG is low, and therefore, its impact on clinical decision-making is limited. Furthermore, detected nodules rarely progress to clinically relevant disease, leading to overdiagnosis and overtreatment. Especially in groups at risk for nodules and malignancy, PE must be combined with imaging methods and, if necessary, pathological examination, even if nodules or goiter are not palpable in PE.
