{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T13:38:49Z","timestamp":1790948329733,"version":"4.1.0"},"reference-count":70,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,12,4]],"date-time":"2024-12-04T00:00:00Z","timestamp":1733270400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Management of clinically unifocal node\u2010negative papillary thyroid carcinoma \u22641\u00a0cm (PTMC) is controversial with nonsurgical treatment as a potential alternative to thyroid lobectomy (TL). However, conservative strategies, such as active surveillance or thermal ablation, do not allow the evaluation of biological aggressive features or occult lymph node metastases (LNMs), which play a primary role as prognostic factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Among 4216 thyroidectomies for malignancy (between September 2014 and September 2023), TL plus ipsilateral central neck dissection was performed in 203 (4.8%) unifocal N0 PTMCs. Completion thyroidectomy was accomplished in case of positive frozen section examination of removed nodes or within 6\u00a0months from index operation in presence of biological aggressive features.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventy\u2010six out of 203 (37.4%) patients were staged pN1a and extranodal extension was detected in 5 (6.6%) patients. At final histology, biological aggressive features, including multifocality, lymphovascular invasion (LVI), extracapsular invasion, tumor aggressive subtypes, and BRAF\u2010V600E mutation, were detected in 69 (34%), 93 (45.8%), 3 (1.5%), 30 (14.8%), and 7 (3.5%) patients, respectively. A comparative analysis between pN0 and pN1a patients showed younger age (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), LVI (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.037), and multifocality (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) as risk factors for occult central LNMs. After logistic regression analysis, age (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) and multifocality (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) were confirmed as independent risk factors for nodal involvement.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although most PTMC has been widely defined as indolent disease, a non\u2010negligible rate of patients may present one or more biologically aggressive features including nodal involvement. Nonsurgical management should be considered with caution to avoid undertreatment especially in the younger population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjs.12440","type":"journal-article","created":{"date-parts":[[2024,12,4]],"date-time":"2024-12-04T20:29:21Z","timestamp":1733344161000},"page":"187-197","source":"Crossref","is-referenced-by-count":7,"title":["Is conservative treatment always safe in unifocal clinically T1a\/node\u2010negative papillary thyroid carcinoma?"],"prefix":"10.1002","volume":"49","author":[{"given":"Francesco","family":"Pennestr\u00ec","sequence":"first","affiliation":[{"name":"UOC Chirurgia Endocrina e Metabolica Fondazione Policlinico Universitario Agostino Gemelli IRCCS  Rome Italy"},{"name":"Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell\u2019Obesit\u00e0 Universit\u00e0 Cattolica del Sacro Cuore  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priscilla Francesca","family":"Procopio","sequence":"additional","affiliation":[{"name":"UOC Chirurgia Endocrina e Metabolica Fondazione Policlinico Universitario Agostino Gemelli IRCCS  Rome Italy"},{"name":"Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell\u2019Obesit\u00e0 Universit\u00e0 Cattolica del Sacro Cuore  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Laurino","sequence":"additional","affiliation":[{"name":"UOC Chirurgia Endocrina e Metabolica Fondazione Policlinico Universitario Agostino Gemelli IRCCS  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annamaria","family":"Martullo","sequence":"additional","affiliation":[{"name":"UOC Chirurgia Endocrina e Metabolica Fondazione Policlinico Universitario Agostino Gemelli IRCCS  Rome Italy"},{"name":"Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell\u2019Obesit\u00e0 Universit\u00e0 Cattolica del Sacro Cuore  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria","family":"Santoro","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino\u2010Metaboliche Fondazione Policlinico Universitario Agostino Gemelli IRCCS  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierpaolo","family":"Gallucci","sequence":"additional","affiliation":[{"name":"UOC Chirurgia Endocrina e Metabolica Fondazione Policlinico Universitario Agostino Gemelli IRCCS  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Prioli","sequence":"additional","affiliation":[{"name":"UOC Chirurgia Endocrina e Metabolica Fondazione Policlinico Universitario Agostino Gemelli IRCCS  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Sessa","sequence":"additional","affiliation":[{"name":"Fondazione Istituto G. 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