Fine needle aspiration is not a risk factor for cervical lymph node metastasis or prognostic factor in papillary thyroid microcarcinoma: A propensity score-matched analysis

crossref(2022)

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Abstract Background Ultrasound-guided fine needle aspiration (UGFNA) has been widely used in clinical practice. Many patients may still worry about UGFNA-related metastasis. The aim of this article was to analyze the potential association between UGFNA and cervical lymph node metastasis (CLNM) of papillary thyroid microcarcinoma (PTMC) and whether UGFNA influences the long-term prognosis of PTMC. Methods A total of 367 adult patients with PTMC who underwent thyroidectomy in our hospital between January 2014 and December 2015 were enrolled in this retrospective cohort study. Univariate and multivariate analyses were conducted to explore the potential risk factors for CLNM. Propensity score (PS)-based 1:1 nearest neighbor matching was performed to select patients with homogeneous baseline characteristics. Then, the rate of CLNM was compared between matched samples with chi-square (χ2) tests. Survival analysis was performed with the Kaplan–Meier method in the PS-matched cohort. The recurrence-free survival (RFS) rate was compared between groups with the log-rank test. Results Multivariate analysis showed that male sex (OR = 3.997, 95% CI 2.148 ~ 7.439, P < 0.01) and larger tumor size (OR = 2.319, 95% CI 1.285 ~ 4.186, P < 0.01) were independent risk factors for CLNM. Younger age (< 55 years, OR = 1.809, 95% CI 0.937 ~ 3.492, P > 0.05), capsular invasion (OR = 1.218, 95% CI 0.415 ~ 3.572, P > 0.05), multifocality (OR = 1.949, 95% CI 0.905 ~ 4.196, P > 0.05) and Hashimoto's thyroiditis (HT) (OR = 0.824, 95% CI 0.401 ~ 1.696, P > 0.05) were not independent risk factors for CLNM. In the PS-matched cohort, the CLNM rate showed no significant difference between the UGFNA and non-UGFNA groups (29.5% vs. 23.7%, P > 0.05). With a median follow-up of 63.8 months (range 3.1–84.9 months), the 5-year cumulative RFS rate was 99.3% in the UGFNA group and 97.7% in the non-UGFNA group. After PS matching, the Kaplan–Meier curves showed no significant differences between groups (P > 0.05). Conclusions UGFNA is a very safe diagnostic tool that does not influence the CLNM rate or long-term prognosis of patients with PTMC. The fear of UGFNA-related metastasis should not deter UGFNA of the thyroid.
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