Objective: This study aims to evaluate the efficacy of secondary sentinel lymph node (SLN) biopsy in cN1a papillary thyroid carcinoma (PTC) surgery, drawing parallels to strategic approaches akin to those employed by athletic players. Methods: We selected eleven patients diagnosed with suspected cN1a PTC from January 2020 to July 2020. Carbon nanoparticles were utilized to mark lymph nodes, analogous to strategic marking in athletic games, ensuring precise identification during surgery. The secondary SLN biopsy technique was implemented, reflecting the precision and planning seen in athletic strategies.

Results: The average tumor size was 12.64±5.63 mm. Notably, 2 patients exhibited extrathyroidal spread, 3 had thyroiditis, and all had neck metastases. The SLN identification rate stood at 100%, mirroring the accuracy expected in athletic performance. Out of the group, 3 patients had sentinel lymph node metastasis, with additional metastasis in non-SLN areas in 1 patient. The detection rate, false-negative rate, and overall accuracy paralleled the high performance and reliability seen in athletic endeavors.

A total of 42 lateral SLNs were identified, with the majority being grade IV. This strategic identification is akin to an athlete's ability to focus on key areas during play. Complications: Resembling the low incidence of injuries in well-trained athletes, only 4 patients experienced transient hypoparathyroidism, with no major complications like nerve injuries or chylous leakage. Conclusion: The secondary SLN biopsy in cN1a PTC surgery, much like a well-executed play in sports, shows promising results in accurately determining lateral neck dissection needs. This technique, mirroring the precision and strategic planning of athletic players, could enhance surgical outcomes in cN1a PTC treatment.