Central lymph node ratio predicting lateral metastasis in pediatric thyroid cancer: a retrospective study

Purpose To explore whether central lymph node ratio (LNR) can be used to predict the lateral lymph node metastasis (LLNM) in pediatric patients with differentiated thyroid carcinoma (DTC) and construct a predictive model. Methods We reviewed the clinicopathological data of patients with DTC (aged ≤14 years) who had thyroid lobectomy (unilateral or bilateral)and therapeutic central neck dissection (CND) with concurrent or staged lateral neck dissection (LND) from 2015 to 2025. Patients were grouped by LLNM status. Receiver Operating Characteristic Curve (ROC) analysis identified the optimal LNR cutoff. Results In univariate analysis, central LNR threshold of 0.4 predicts LLNM with a sensitivity of 90.0%, specificity of 76.0%, and OR of 11.374.Multivariate analysis identified central LNR (OR = 3.741), bilaterality (OR=3.850), and ≥4 metastatic central nodes (OR = 4.732) as independent predictors. Conclusion Central LNR, bilaterality, and ≥4 metastatic central lymph nodes were independent predictors. An LNR ≥0.4 serves as a key indicator for identifying high-risk pediatric DTC patients.