Papillary thyroid cancer (PTC) is the most common endocrine malignancy, and its incidence has increased worldwide over the past decades. Although disease-specific survival is favourable, cervical lymph node metastases remain a significant clinical challenge. While lymph node metastases have limited impact on overall survival, they are associated with an increased risk of locoregional recurrence, repeated surgical procedures, and long-term morbidity.

Accurate assessment of lymph node status is therefore an important component of treatment planning in PTC. However, current preoperative staging relies primarily on ultrasound and CT scans, both of which have limitations in detecting small-volume nodal disease. As a result, occult lymph node metastases are frequently discovered during follow-up and often lead to re-operation. On the other hand, extensive primary surgery performed because of suspected nodal involvement may expose patients to complications such as recurrent laryngeal nerve injury and permanent hypoparathyroidism.

The biological behaviour of PTC varies considerably between patients. While many tumours remain indolent, others demonstrate aggressive features including lymphatic spread and recurrent disease. Previous studies have identified several molecular alterations associated with tumour aggressiveness. However, the clinical utility of these markers for predicting lymph node metastases remains poorly understood, and no molecular model has yet been incorporated into routine clinical decision-making.

The aim of this project is to identify molecular markers associated with lymph node metastases in PTC and to develop predictive models capable of identifying patients with N0 disease from those with occult or clinically evident nodal metastases.

The project will investigate the relationship between genetic alterations, gene expression profiles, and lymph node status in a large cohort of patients treated for PTC. Molecular findings will be correlated with clinical and pathological characteristics to identify factors associated with metastatic spread.
The long-term goal is to improve preoperative risk stratification and support more individualized treatment strategies in thyroid cancer. Better prediction of lymph node metastases may help optimize surgical planning and reduce both undertreatment and unnecessary surgery.