MINI REVIEW article
Front. Endocrinol.
Sec. Cancer Endocrinology
Lymphatic metastasis of papillary thyroid carcinoma: Mechanism and clinicopathological physiology
Provisionally accepted
- Qingdao Municipal Hospital Group, Qingdao, China
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Lymphatic metastasis is a hallmark feature of papillary thyroid carcinoma (PTC), occurring in 30–80% of patients and significantly influencing clinical management. This review comprehensively examines the biological, anatomical, and clinical characteristics of lymphatic spread in PTC, focusing on its diagnostic and therapeutic implications. We detail the molecular mechanisms driving lymphangiogenesis, including the VEGF-C/VEGFR-3 axis and immune-evasion pathways, and highlight the distinct patterns of regional lymph node involvement—from central compartment (Level VI) to lateral (Levels II–V) and rare skip metastases. High-risk clinicopathological features, such as tumor size >2 cm, extrathyroidal extension, and aggressive histological variants, are discussed alongside molecular markers (BRAF V600E, TERT, RET/PTC) that predict metastatic potential. Management strategies are reviewed, balancing the benefits of prophylactic central neck dissection against its risks and emphasizing risk-adapted radioactive iodine therapy. Despite the frequency of lymphatic metastasis, its prognostic impact varies: microscopic nodal disease has minimal effect on survival, while macroscopic or extranodal extension increases recurrence and mortality risks. This synthesis of current evidence aims to guide clinicians in optimizing detection, treatment, and surveillance for PTC patients with lymphatic metastasis.
Keywords: Papillary thyroid carcinoma, Lymphatic Metastasis, Lymph node dissection, BRAF mutation, Radioactive iodine
Received: 14 Oct 2025; Accepted: 30 Nov 2025.
Copyright: © 2025 Yu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xianqiang Yu
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