Background: Prophylactic central lymph node dissection (pCND) in papillary thyroid carcinoma (PTC) is still a matter of debate. Therefore, we aimed to identify the factors affecting central lymph node metastasis (CLNM) in patients with clinically node-negative (cN0) PTC. Methods: This retrospective study included 248 patients with cN0 PTC who underwent total thyroidectomy (TT) or TT + pCND. Clinicopathological associations among CLNM, complication rates and the effect of pCND on staging were assessed. Risk factors (RFs) and the pattern of lymph node metastasis (LNM) in PTC patients were studied via multivariate analysis. Results: A total of 216 patients underwent pCND, and 58.8% (127/216) had positive CLNM. Male patients, aged < 41 years, and those with lymphatic invasion were identified as RFs for CLNM, with odds ratios of 2.59, 2.26, and 4.09, respectively. Among the 216 patients, 65 (30%) had transient hypoparathyroidism (HPT), and 20 (9.3%) had permanent HPT. Transient recurrent laryngeal nerve (RLN) palsy occurred in 15 (6.9%) patients, and permanent RLN palsy occurred in 3 (1.4%) patients. Over 55 years of age, 46.7% of patients were upstaged according to the American Joint Committee on Cancer (AJCC) TNM staging system, and 14.2% (n = 18) of the 127 patients with CLNM were upgraded according to the American Thyroid Association (ATA) risk stratification system (RSS). Conclusion: Taken together, in terms of the high incidence rate of CLNM in cN0 PTC patients; We believe that routine pCND, which can be performed with low morbidity rates, is optimal for cN0 PTC patients during their first treatment, especially for those with RFs for CLNM. Clinical trials number: NCT05873283.

Background: The completeness of surgical resection is a key factor influencing outcomes in patients with papillary thyroid carcinoma (PTC) and regional lymph node metastases. However, the optimal extent of therapeutic lateral neck dissection remains a matter of debate This study aimed to assess the diagnostic accuracy of preoperative ultrasonography (US) in detecting lateral lymph node metastasis (LLNM) in patients with PTC and to identify clinical and pathological factors predictive of metastases at levels II and V.Methods: This retrospective study included consecutive patients with PTC who underwent comprehensive lateral neck dissection at a single tertiary center between June 2020 and July 2024.Results: In 63 patients, a total of 78 comprehensive lateral neck dissections were performed. Of the patients, 41 (65%) were male and 22 (35%) were female, with a median age of 37 years (range, 24–49 years). Lymph node metastases were identified in 46 (58.9%), at level II, 561 (78.2%) at level III, 60 (76.9%) at level IV, and 9 (11.5%) at level Vb. Metastasis to level IIb was detected in 5 dissections. Among the 9 patients with level Vb metastases, 7 (77.8%) had involvement of four different cervical levels. The specificity of US in identifying metastatic disease was notably high at both level II (80%) and level Vb (87%). Independent predictors of metastatic involvement at level II and level Vb lymph nodes was associated with extrathyroidal extension [level II: odds ratio (OR) 7.88, p=0.03; level V: OR 6.91, p=0.043] and a largest metastatic lateral lymph node size above 2 cm [level II: OR 18.58, p=0.03; level V: OR 11.32, p=0.03].Conclusion: Routine dissection of level IIa is recommended in N1b PTC due to high metastasis rates. However, level IIb dissection may be omitted in selected cases given its low metastasis rate and potential morbidity, with intraoperative frozen section serving as a useful guide. Similarly, level Vb dissection may be avoided when lateral lymph nodes are <2 cm, multilevel involvement is absent, and ultrasonographic findings are negative.

Background/Objectives: Advances in the genetic understanding of pheochromocytoma–paraganglioma (PPGL) have considerably refined personalized approaches to diagnosis and management. This study aims to present our institutional experience on the diagnostic characteristics, clinical course, and genetic background of patients with PPGL, in the context of the current literature. Methods: This retrospective analysis included 35 patients diagnosed with PPGL between years 2020 and 2024, all of whom underwent surgical resection and next-generation sequencing for germline mutations in major PPGL susceptibility genes. Clinical presentation, biochemical profile, pathological findings, and follow-up outcomes were compared between mutation-positive and mutation-negative cases. Results: Of the 35 patients with PPGL, germline mutations were identified in 6 patients (17%): 2 in Cluster 1A genes (SDHA, SDHB), 2 in Cluster 1B (VHL), and 2 in Cluster 2 (NF1). Consistent with existing literature, pathogenic germline variants—particularly SDHB and VHL—were identified in our cohort exclusively in patients younger than 30 years (ages 17, 20, and 25). Mutation-positive patients more frequently exhibited noradrenergic or non-secretory profiles (p = 0.01). Among the three non-secretory tumors in the cohort, two harbored genetic mutations (SDHA, NF1). Interestingly, both NF1-positive patients were normotensive—one (c.3496G > A) with a non-secretory tumor and the other (c.2329T > A) presenting at an unusually late age (63 years)—a strikingly atypical spectrum that underscores the phenotypic variability of NF1-associated PPGL. Bilateral disease was observed exclusively in VHL carriers (p = 0.03). Importantly, we identified a rare VHL c.369delG frameshift variant, not previously reported in association with PPGLs, in a patient with PPGL. No significant difference was observed between SDHB loss (p = 0.1) and proliferative indices (mitotic count, Ki-67) (p = 0.07, p = 0.6) between the two groups. During a median follow-up of 24 months (IQR: 18–36), one SDHB-positive patient had a recurrence, while no distant metastases were detected in the remaining mutation carriers. Conclusions: These findings support characteristic clinical patterns among mutation-positive PPGL and underscore the importance of systematic germline testing in all cases—irrespective of age, family history, or biochemical profile—to guide individualized management and enable cascade screening. The identification of a rare VHL c.369delG variant, previously unreported in association with PPGL, within a characteristic VHL-related clinical phenotype highlights the importance of this association. Similarly, atypical NF1 cases emphasize phenotypic variability and reinforce the importance of germline testing even in clinically silent presentations.

American Thyroid Association (ATA) argues that the prevalence of malignancy of the indeterminate nodules may vary substantially among regions, and states that it is crucial to know the prevalence of malignancy within each indeterminate cytological category at one’s institution. Our aim is to draw attention to the malignancy rates of indeterminate nodules that cannot be underestimated in an endemic region and raise awareness to differences across different populations. Between March-2021 and June-2024, 13,531 fine needle aspirations were performed on thyroid nodules in a single institution. Of these 2121 nodules were classified as indeterminate (Bethesda III–IV) and 242 patients underwent surgery. Demographic characteristics, nodule size, risk of malignancy, tumor types and subtypes were evaluated. The necessity of radioactive iodine (RAI) therapy and consequent completion thyroidectomy was investigated. Of the 242 patients 123 (50.8%) underwent lobectomy and 119 (49.2%) underwent total thyroidectomy. In total, 115 (47.5%) of 242 patients resulted in malignancy (186 patients were Bethesda-III and 82 (44.1%) of them were malignant; 56 were Bethesda-IV and 33 (58.9%) of them were malignant). Incidental carcinoma was detected in a different focus other than the indeterminate nodule in 17 patients. RAI therapy was indicated in 39 patients (33.9%) primarily based on the ATA guideline, and 24 (20.8%) patients who initially underwent lobectomy required completion thyroidectomy. Risk of malignancy in indeterminate thyroid nodules varies endemically. Each region should know their own risk and each patient’s treatment should be tailored accordingly. In this way, under-overtreatment and related morbidities will be prevented.