Abstract
BackgroundThe indications and extent of cervical lymph node dissection in papillary thyroid carcinoma (PTC) are still being debated. The aim of this study was to analyze the patterns of cervical lymph node metastasis in the lateral and central compartment and related factors and suggest the optimal extent of lateral and central neck dissection for PTC patients with clinical lateral lymph node metastasis.MethodsWe retrospectively analyzed 72 patients with unilateral PTC who underwent therapeutic lateral neck dissections with concomitant total thyroidectomy and central neck dissection between January 2001 and December 2009.ResultsThe 72 patients underwent 79 sides of therapeutic lateral neck dissection. The most frequent metastatic level in the ipsilateral lateral compartment was level IV (75.0%), followed by level III (69.4%), level II (56.9%) and level V (20.8%). Multiple level metastases were common (77.8%) and were correlated with tumor size (≥ 10 mm). The central compartment lymph node metastasis rate was 87.5%, including 26.4% of contralateral central compartment metastases.ConclusionIn PTC patients with clinical lateral lymph node metastasis, the optimal extent of lateral and central neck dissection should include levels II, III, IV and V as well as the bilateral central compartment.
Highlights
The indications and extent of cervical lymph node dissection in papillary thyroid carcinoma (PTC) are still being debated
Because there is no evidence for the clinical significance of prophylactic lateral neck dissection, there is no consensus on its application among surgeons worldwide, some Japanese surgeons recommend prophylactic lateral neck dissection for large primary tumor or massive extrathyroidal extension [5,6]
Therapeutic lateral neck dissection should be performed on patients who have PTC with clinically apparent cervical lymph node metastasis detected on palpation or imaging studies [7,8,9]
Summary
The indications and extent of cervical lymph node dissection in papillary thyroid carcinoma (PTC) are still being debated. The aim of this study was to analyze the patterns of cervical lymph node metastasis in the lateral and central compartment and related factors and suggest the optimal extent of lateral and central neck dissection for PTC patients with clinical lateral lymph node metastasis. Therapeutic lateral neck dissection should be performed on patients who have PTC with clinically apparent cervical lymph node metastasis detected on palpation or imaging studies [7,8,9]. There is no evidence to prove which approach is most appropriate for the management of lateral compartment lymph node metastasis, most specialists believe that the berry-picking procedure should be avoided for initial therapeutic lateral neck dissection [10]
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