Correlation between Central and Lateral Neck Dissection in Differentiated Thyroid Carcinoma

Olivia Mazzaschi,Nathalie Chabbert-Buffet,Bruno Angelard,Jean Lacau St Guily,Sophie Périé,Marine Lefevre

doi:10.4236/ijohns.2012.13022

Olivia Mazzaschi, Nathalie Chabbert-Buffet + Show 4 more

Open Access

https://doi.org/10.4236/ijohns.2012.13022

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Abstract

Objective: To determine the histopathological correlation between central and lateral neck metastasis in differentiated thyroid carcinoma, and its potential therapeutic impact. Although the central neck dissection (CND) is recommended in differentiated thyroid carcinoma, the indication for lateral neck dissection (LND) remains controversial. Design: Retrospective study. Methods and Main Outcome Measures: Pathological analysis of systematic ipsilateral central neck dissection (CND) and LND performed with total thyroidectomy in differentiated thyroid carcinoma was retrospectively reviewed according to “side” and to “patient”. Results: A total of 56 sides (46 patients) were suitable for analysis. Analysis by “side” revealed that CND and LND dissection samples were both negative in 15 cases, both positive in 32, CND was positive and LND was negative for 8 cases and CND was negative and LND was positive in 1 case. The combined presence of positive LND and positive CND was therefore observed in 32/40 “sides” and 26/46 “patients”. Analysis by “side” of the impact of the treatment decision to perform ipsilateral LND only in patients with positive CND and vice versa demonstrated a sensitivity, specificity, and accuracy of 97%, 65%, and 84%, respectively. Conclusions: In most cases, the presence of positive LND was associated with positive ipsilateral CND. The very low prevalence of positive LND in patients with negative CND may justify LND as a second step procedure only in patients with positive CND, except in the case of documented lateral neck metastasis.

Highlights

Discussion on the treatment of differentiated thyroid carcinoma currently focuses on the indications for prophylactic neck dissection
It has been shown that central neck dissection (CND) should be routinely combined with thyroidectomy in papillary carcinoma and microcarcinoma with aggressive criteria to decrease the risk of recurrence [1,2]
In order to more clearly define the indications for lateral neck dissection (LND) in differentiated thyroid carcinoma, we studied the correlation between LND and CND according to “side”, performed routinely in our department in patients with differentiated thyroid carcinoma

Summary

Introduction

Discussion on the treatment of differentiated thyroid carcinoma currently focuses on the indications for prophylactic neck dissection. It has been shown that central neck dissection (CND) should be routinely combined with thyroidectomy in papillary carcinoma and microcarcinoma with aggressive criteria to decrease the risk of recurrence [1,2]. The indication for lateral neck dissection (LND) remains controversial, especially in patients with no clinical and/or ultrasound evidence of lateral lymph node metastasis. Criteria of aggressive thyroid tumour such as size larger than 3 cm, multifocal tumour, extracapsular spread, vascular invasion [5], and central node involvement, are currently established only at final pathological analysis, resulting in a difficult preoperative decision regarding appropriate neck dissection. LND could possibly be withheld in patients without metastasis in the central compartment, as neck metastases commonly start by involving the central nodes and subsequently spread to lateral nodes. “skip” metastases (positive nodes in the LND, and negative nodes in the CND) have been reported in the literature in 6% to 19.7% of papillary carcinomas [6,7,8] and 4.2% to 5.5% of IJOHNS

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