Sudoko CK, Jenks CM, Bauer AJ, et al. - The results of this cohort analysis suggest that in patients with unifocal T1a papillary thyroid cancer (PTC) and no clinically visible nodal disease on preoperative ultrasonography, a thyroid lobectomy and central neck dissection should be considered. Close observation may be undertaken if there is no sign of unilateral multifocality or if there are fewer than 4 positive lymph nodes on postoperative pathology. Such findings have significant clinical consequences and may lead to changes in practice regarding the scope of thyroid surgery on low-stage pediatric PTC.

• In total, 102 patients (mean age, 15.3 years [range, 9.7-18.9 years]; 84 girls [82.4%]) were involved in the investigation.

• Ten (19.2%) of the 52 patients with T1a tumors had bilateral disease, and 15 (28.8%) had central neck lymph node (N1a) metastasis.

• Ten (20%) of the 50 patients with T1b tumors had bilateral disease, while 13 (26%) had N1a disease.

• Unilateral multifocality was related to bilateral disease and N1a disease in individuals with T1a.

• Bilateral disease was related to both N1a disease and ≥ 4 positive lymph nodes.

• There was a 95% probability of unilateral PTC in patients with no pathologic evidence of lymph node metastasis (N0).

• Unilateral multifocality was likewise related to bilateral disease in patients with T1b tumors.

• When compared with T1a tumors, patients with T1b tumors had a higher probability of lateral (N1b) neck lymph node metastasis.