Central Lymph Node Metastasis as a Predictor for Lateral Lymph Node Metastasis in Clinically Node-Negative T3 and T4 Papillary Thyroid Carcinoma

Abstract

Background: To evaluate the pattern of lateral lymph node metastasis（LLNM）and the impact of central lymph node metastasis (CLNM) on lymph node resection at level II-V in clinically node-negative（cN0）T3 and T4 papillary thyroid carcinoma (PTC) patients. Methods: 151 patients with PTC who underwent total thyroidectomy plus bilateral central lymph node dissection (CLND) and unilateral lymph node dissection (LLND) were retrospectively reviewed. Results: We used univariate and multivariate regression analysis to investigate risk factors of LLNM and the pattern of LLNM in PTC. 1) CLNM was a risk factor for LLNM (odds ratio of 2.776). 2) The numbers of involved central lymph nodes were positively correlated with the incidence of LLNM and the number of LLNM involved regions. Conclusions: The number of central lymph nodes involved correlated with higher LLNM, total thyroidectomy plus bilateral central lymph node dissection (CLND) should be first considered for the T3 and T4 PTC patients in which we recommended modified radical cervical lymph nodes dissection to remove the ipsilateral level II-V lymph nodes