Bilateral Central Compartment Neck Dissection Research Articles

Clinico-pathological initial outcome of a newly adopted novel surgical technique for nodal metastatic thyroid cancer at a large-volume centre in a high-income developing country.

Thyroid cancer is the most common tumour in the endocrine system. In the past decade, the incidence of lymph node metastasis has increased, and so has the patient demand for a smaller scar. This research reports the surgical and patho-oncological short-term outcomes of a novel, minimally invasive neck dissection approach for thyroid carcinoma with lymph node metastases at the UAE's leading endocrine surgery centre. This study employed a prospectively maintained surgical database to retrospectively analyse relevant parameters such as surgical complications, including bleeding, hypocalcaemia nerve injury and lymphatic fistula, as well as oncological metrics such as the type of tumour and the ratio of lymph node metastasis to the number of harvested lymph nodes in 100 patients that underwent open minimally invasive selective neck dissection. The study comprised 50 patients with thyroidectomy, with bilateral central compartment neck dissection (BCCND; 50%); 34 with thyroidectomy, BCCND and selective bilateral lateral compartment neck dissection (BLCND; 34%); and 16 patients with selective unilateral central and lateral compartment neck dissection by recurrent nodal disease (ULCND; 16%). The female-to-male gender ratio was 78:22, with median ages of 36 and 42 years, respectively. Histopathology findings revealed that 92% of patients had papillary thyroid cancer (PTC) and 8% had medullary thyroid cancer. The mean total number of lymph nodes removed was 22 in the BLCND group, 17 in the ULCND group and 8 in the BCCND group (p = 0.001). Furthermore, the average lymph node metastasis was significantly higher in the BLCND group (p = 0.002). The percentage of temporary hypoparathyroidism was 29.8% and it persisted for 1.3%. The lateral compartment dissection morbidity was as follows: Four male patients with tall cell infiltrative PTC presented with pre-existing vocal cord paresis, necessitating nerve resection and anastomosis, and two more developed it after surgery (1.1% of the nerve at risk). Lymphatic fistulas occurred in four patients (4%) who were treated conservatively. Two patients were readmitted due to symptomatic neck collection. Horner syndrome was discovered in just one female patient. Male gender, aggressive histology and lateral compartment dissection independently increased surgical morbidity. In a high-volume endocrine centre, the adoption of minimally invasive selective neck dissections to treat nodal metastatic thyroid cancer did not increase specific cervical surgery complications.

Preoperative supplementation of calcitriol and calcium relieves symptom and extent of hypocalcemia in patients undergoing total thyroidectomy and bilateral central compartment neck dissection: A prospective, randomized, open-label, parallel-controlled clinical study.

BackgroundHypocalcemia is the most common complication that challenges surgeons performing total thyroidectomy. Conventional postoperative calcium and calcitriol supplement has been reportedly effective; however, a time lag has been reported before taking effect. Therefore, the role of preoperative strategy is yet to be determined.Study designIn this prospective, randomized, open-label, parallel-controlled phase II clinical study (registration number: ChiCTR2200059815), a short-term preoperative administration of calcitriol and calcium was proposed in 210 patients undergoing total thyroidectomy and bilateral central compartment neck dissection. Patients were recruited and randomized (1:1:1) into three groups: (A) combined (preoperative calcitriol and calcium), (B) calcium only (preoperative calcium only), and (C) control (no preoperative intervention). Finally, a total of 172 patients were qualified for final analysis.ResultsOur data showed that 16 of 63 patients (25.4%) in the combined group had symptomatic hypocalcemia, whereas more patients from the control group (25 of 57 patients, 43.9%, P = 0.033) had symptomatic hypocalcemia. Further, the postoperative calcium level in the combined group is higher than in the control group (2.15 ± 0.15 vs. 2.09 ± 0.15 mmol/L, P = 0.031). Moreover, patients from the combined group showed lower calcium rates of <2.00 mmol/L (12.7% vs. 28.1%, P = 0.036). Remarkably, compared with the control group, patients with transient hypoparathyroidism in the combined group showed fewer rates for both symptomatic and biochemical hypocalcemia (28.6% vs. 61.1% for symptomatic hypocalcemia; 47.6% vs. 75% for biochemical hypocalcemia). Patients without transient hypoparathyroidism in all three groups showed no significant difference in rates for either symptomatic or biochemical hypocalcemia, indicating that this preoperative strategy is only effective for patients with transient hypoparathyroidism. We did not observe such beneficial effects in patients from the calcium group.ConclusionsPreoperative administration of calcitriol and calcium could reduce symptomatic and biochemical hypocalcemia, especially for those with transient hypoparathyroidism. Moreover, this maneuver could be recommended as a clinical routine in patients undergoing total thyroidectomy and bilateral central compartment neck dissection.Clinical Trial Registration http://www.chictr.org.cn/edit.aspx?pid=164316&htm=4, identifier ChiCTR2200059815.

Outcomes of parathyroid gland identification and autotransplantation during total thyroidectomy.

To report the outcomes of parathyroid gland (PG) identification and autotransplantation (autoT) during thyroidectomy. Consecutive total thyroidectomy cases performed by a single surgeon using extracapsular dissection technique were considered. PGs were not intentionally sought during dissection. PG location, number identified and autoT were prospectively recorded and correlated to postoperative outcomes. In all, 265 cases were included. The mean number of PGs identified per case was 2.7. The number of PGs identified had no correlation to postoperative hypocalcemia. However, independent risk factors for hypocalcemia were female sex, bilateral central compartment neck dissection (CND) and autoT > 1 PG; and for permanent hypoparathyroidism were female sex and bilateral CND. AutoT did not protect against permanent hypoparathyroidism. The number of PGs identified during the course of a standard extracapsular dissection technique had no correlation to postoperative hypocalcemia. Whenever possible, avoiding bilateral CND and careful techniques to preserve PGs in an in situ and viable state, to obviate the necessity for autoT, are recommended.

The extent of lymph node yield in central neck dissection can be affected by preoperative and intraoperative assessment and alter the prognosis of papillary thyroid carcinoma.

BackgroundLymph node yield (LNY) was implemented in the stratification of papillary thyroid cancer (PTC) patients. The effect of LNY may be related to the extent of surgery. This study aims to identify influencing factors for LNY in central compartment neck dissection (CND).MethodsData of 13 712 consecutive PTC patients were analyzed retrospectively. Risk factors for LNY in CND and distribution characteristics of LNY were evaluated. Its relationship with prognosis was studied in another cohort of 136 cases.ResultsLNY in therapeutic CND was significantly higher than prophylactic CND (Unilateral: 5.55 ± 3.79 vs 3.41 ± 2.77; Bilateral: 8.90 ± 5.10 vs 6.47 ± 4.17, P < .001). Other independent factors included extranodal extension (ETE), tumor size, and concurrent Hashimoto's thyroiditis. The inconsistency distribution of LNY in bilateral CND was associated with preoperative and intraoperative assessment. Patients with significant difference between major and minor LNY suffered from poorer prognosis (10y‐RFS: 58.3% vs 92.0%; HR = 6.719, 95%, P < .0001).ConclusionsCND surgical procedure, ETE, and Hashimoto's thyroiditis were independent factors of LNY. Inconsistent distribution of LNY was associated with prognosis of bilateral PTC patients. The impact of preoperative and intraoperative assessment on the actual extent of CND can be used to explain the relationship between LNY and PTC prognosis.

A nomogram predicting contralateral central neck lymph node metastasis for papillary thyroid carcinoma.

Central compartment neck dissection (CCND) is recommended for patients with papillary thyroid carcinoma (PTC). However, whether to perform contralateral CCND remains unclear. An individualized estimation of the contralateral central neck metastasis (CNM) risk would assist in the tailoring of treatment for PTC patients. Consecutive patients who underwent bilateral CCND for unilateral PTC between 2012 and 2014 in a tertiary center were identified. The clinicopathological data of 142 patients were analyzed retrospectively. The variables that had clinical significance in the final multivariate logistic regression model were built into a nomogram to assess the risk of metastasis of the contralateral central compartment. This model was internally validated using bootstrap resampling. This nomogram demonstrated good calibration and discrimination, with a concordance index of 0.834 (bootstrap corrected, 0.824). The variables with the greatest influence on the risk of contralateral CNM in this model included tumor size, the number of positive lymph nodes, and extranodal extension in the ipsilateral central neck. This nomogram integrates three variables to estimate an individualized risk of contralateral CNM in unilateral PTC patients. This model may assist in individual decision-making regarding contralateral CCND and help avoid the over- and under-treatment of PTC. J. Surg. Oncol. 2016;114:703-707. © 2016 Wiley Periodicals, Inc.

Anatomic Variability of the Upper Mediastinal Lymph Node Level VII.

Lymph node level VII, between the sternal notch and the innominate artery, is a frequent site of lymph node metastases in thyroid cancer. The objective of this study was to determine the cranial-caudal dimensions of level VII in patients undergoing central neck dissection for thyroid cancer and its accessibility through a neck incision only. Consecutive patients undergoing central neck dissection for thyroid cancer, with no previous neck dissection, mediastinal or thoracic surgery. The innominate artery was identified and the distance between the sternal notch and the upper border of the artery was measured to the nearest .5mm. The sizes of level VII were compared with respect to age, sex, height, body mass index, type of neck dissection (therapeutic or prophylactic), and the incidence of previous thyroidectomy. One-hundred-one consecutive patients (65 women, 36 men, mean age 44years (range 15-87) underwent prophylactic (n=55) or therapeutic (n=46) bilateral central compartment neck dissection. Level VII was accessible via the horizontal neck incision in all cases. Sizes of level VII ranged from 6cm above the sternal notch to 35mm below the sternal notch, with a mean distance of 3.5mm below the sternal notch. The innominate artery was at the level of the sternal notch in 29 patients, and cranial to the sternal notch in 20 cases. No statistical relationship with age, sex, therapeutic/prophylactic neck dissection, previous surgery, body mass index or height was found. The maximal distance below the sternal notch was 35mm. Level VII did not exist in 49% of patients, and was less than 25mm caudal to the sternal notch in 95% of cases. Distinguishing level VII from level VI in thyroid cancer surgery may not be pertinent, due to the ease of access via a classic horizontal neck incision and the small sizes of level VII in the majority of patients.

Malignant Thyroid Teratoma

ABSTRACT Objective: Malignant teratomas of the thyroid are very rare, with less than 30 cases reported in adults. Presentation of a recent patient and a review of the literature have provided insight into the usual clinical presentation and histopathologic characteristics of malignant teratomas of the thyroid gland in adults and the available management options for this disease process. Methods: A healthy 33-year-old woman presented with a rapidly growing right neck mass. Fine-needle aspiration demonstrated poorly differentiated carcinoma favoring thyroid origin. The patient underwent total thyroidectomy, bilateral central compartment neck dissection, and right lateral neck dissection. Histopathologic analysis confirmed the diagnosis of malignant teratoma of the thyroid gland with metastases to the neck bilaterally. Results: Malignant teratomas are exceedingly rare tumors of the thyroid gland. These masses are typically diagnosed after thyroidectomy by histopathologic criteria. Fine-needle biopsy generall...

Moans, Bones, Groans, and a Thyroid Mass

Parathyroid carcinoma accounts for less than 1 per cent of cases of primary hyperparathyroidism.1, 2 Its synchronous occurrence with thyroid carcinoma is rarer still, with only seven such patients previously reported in the literature.3, 4 We report another case, unique not only because the parathyroid carcinoma was found within the left thyroid lobe but also because of the presence of a synchronous papillary thyroid carcinoma within the contralateral thyroid lobe. The case illustrates the need for surgeons to be aware of the possibility of concomitant thyroid pathology and the potential for the synchronous occurrence of other endocrine neoplasms. Our case is a 56-year-old female who presented with hypercalcemia, complaints of pain in her left shoulder and hip and a history of recurrent kidney stones over a period of several months. One year prior to the present admission she had undergone an extensive workup for an intrathyroidal lesion located within the central aspect of the left thyroid lobe and for bilateral adrenal incidentalomas measuring 4.3 cm on the right and 1.7 cm on the left. Fine-needle aspiration biopsy of the thyroid nodule revealed parathyroid tissue. Biopsy of the larger of the two adrenal lesions was negative for malignancy. At that time she had bilateral ureteral stents placed for obstructive uropathy. She was discharged with instructions to follow up after recovery from her ureteral stenting to undergo resection of her presumed intrathyroidal parathyroid adenoma. She subsequently was readmitted because of worsening bone pain. On her subsequent presentation, physical examination her of head, neck, and cervical nodal basins were normal. Laboratory evaluations revealed hypercalcemia with a serum level of 12.2 mg/dL and a parathyroid hormone (PTH) level of 1246 pg/mL. Radiological imaging confirmed pyelocalyectasis from an obstructed stent in her left ureter and areas of osteitis fibrosa cystica in her left iliac crest and left humeral head. She was treated with intravenous saline infusion, diuresis, and cinacalcet (Sensipar™, Amgen™, Thousand Oaks, CA) to acutely control her hypercalcemia. A percutaneous nephrostomy tube was placed within the left renal pelvis and replacement of both ureteral stents were performed to relieve her recurrent obstructive uropathy. Ultrasound demonstrated two lesions in the thyroid: a solid 5.6 × 3 × 3.4 cm mass in the left lobe and a 1.4-cm hypoechoic lesion in the central aspect of the right lobe. A Single-photon emission computed tomography (SPECT-CT) study demonstrated the presence of an intrathyroidal mass within the left lobe with imaging characteristics consistent with parathyroid tissue (Fig. 1A and B). A 24-hour urine for metanephrines and vanillylmandelic acid were within normal limits. Fig. 1 SPECT-CT Scan, (A) Nuclear parathyroid imaging. (B) Tracer accumulation in left thyroid bed. She underwent total thyroidectomy and biopsy of the remaining three parathyroid glands. The right thyroid lobe contained a firm mass surrounded by a sclerotic capsule and frozen section confirmed the mass in the right lobe to be a follicular variant of papillary thyroid carcinoma. Pathology also confirmed intrathyroidal parathyroid carcinoma in the left lobe. A bilateral central compartment neck dissection was then performed. Final pathological examination confirmed the presence of both carcinomas, and demonstrated nodal metastases of papillary carcinoma to the right paratracheal lymph nodes. Intraoperative PTH determinations were obtained and demonstrated a drop from a preexcision level of 3300 pg/mL to a steady state value of 259 pg/mL at 60 minutes. The patient was scheduled to receive radioactive I131 ablation and was given levothyroxine at a dose sufficient to achieve thyroid-stimulating hormone suppression due to her nodal metastases. She underwent periodic measurements of serum calcium and PTH for follow-up of her parathyroid carcinoma. In addition, laparoscopic resection of her 4.3-cm nonfunctioning adrenal incidentaloma is planned, as is close follow-up of the contralateral smaller adrenal lesion to ensure benign biologic behavior. Parathyroid carcinoma, itself a rare tumor may be very rarely accompanied by synchronous thyroid cancer. More commonly parathyroid carcinoma may coexist with another parathyroid disease process, such as a parathyroid adenoma, hyperplasia, or a second parathyroid carcinoma.1–4 Our case of synchronous thyroid and parathyroid carcinomas is only the eighth such case reported3–4 (Table 1), and the first to coexist with bilateral adrenal incidentalomas. The spectrum of endocrine neoplasms encountered in this patient suggests the possibility that she has a genetic predilection for the development of endocrine neoplasia, albeit not the classically described syndromes of multiple endocrine neoplasia 1 or 2. Table 1 Previous Reported Cases of Synchronous Thyroid and Parathyroid Carcinoma

Clinical Significance of Delphian Lymph Node Metastasis in Papillary Thyroid Carcinoma

Delphian lymph node (DLN) metastasis has long been considered a prognostic marker of head and neck malignancy. These days, the significance of DLN in thyroid cancer has come to the fore. The objective of the present study was to evaluate the clinical significance of DLN metastasis in patients with papillary thyroid cancer (PTC). The study was carried out between July 2009 and December 2011, and DLN was detected in 245 of 898 PTC patients who underwent total thyroidectomy and bilateral central compartment neck dissection. In those 245 patients DLN status was correlated with clinical and pathologic factors, including age, gender, tumor size, extrathyroidal extension (ETE), lymphovascular invasion (LVI), and central and lateral nodal metastasis. DLN metastasis was found in 20 % of the patients studied (49 of 245), and DLN metastasis was correlated with tumor size, multicentricity, bilaterality, and LVI excluding ETE (all p < 0.05). The proportion of male patients was higher in the DLN metastasis positive group than in the DLN metastasis negative group (34.7 vs. 13.3 %; p < 0.05). Most of the patients (95.9 %) with DLN metastasis had other central neck node metastasis, and the metastatic central lymph node ratio was higher (0.38 ± 0.23 versus 0.09 ± 0.16; p < 0.001) and lateral neck node metastasis was more common (2.6 vs. 32.7 % <0.001) than in patients without DLN metastasis. For central and lateral compartment nodal metastasis, DLN status had sensitivity, specificity, positive and negative predictive values of 100, 37.4, 58.1, and 100 %, and 85.3, 76.2, 97.4, and 32.7 %, respectively. Multivariate analysis showed that the factors affecting DLN involvement were tumor size and LVI. Patients with positive DLN were ~1.6 times more likely to have further central compartment disease and 3.6 times more likely to have lateral compartment disease. DLN metastasis in patients with PTC is related to a number of poor prognostic factors. Furthermore DLN involvement implies that the patients are predicted to have heavy burden of central neck node metastasis and are more likely to have further lateral neck node metastasis. It is recommended that DLN is evaluated and dissected in all patients with thyroid cancer. If DLN metastasis is suspected, the surgeon should thoroughly dissect the central neck compartment and pay particular attention to the lateral lymph node compartments.

CLN Metastasis with Papillary Thyroid Cancer in the Isthmus

Objective: To investigate the patterns and predictive factors of central lymph node metastasis in patients with papillary thyroid cancer located in the isthmus. Method: Retrospective chart review. We evaluated 447 cases with solitary nodule out of 1257 patients with papillary thyroid cancer who underwent total thyroidectomy with bilateral central lymph node compartment dissection. The patients were analyzed in 2 groups: group I, patients with cancer located in the isthmus (n = 35) and group II, patients with cancer in other regions (n = 412). We evaluated the clinicopathological characteristics and predictive factors and compared the 2 groups. Results: The frequency of central lymph node(CLN) involvement was 52.1% (233 cases) in the patients with single nodule of papillary thyroid cancer. The frequency of papillary thyroid cancer located in the isthmus was 7.8% (35 cases). Mean age at diagnosis in group I and II was 45.3 years and 46.2 years, respectively ( P = .892). Size, sex, extrathyroidal extension, and ultrasound findings (eg, marked hypoechoic, taller than wide) showed no significant difference between the 2 groups. CLN metastasis in group I and group II was 62.5% and 56.5%, respectively ( P = .228). Bilateral CLN metastasis was 18.8% in group I and 11.5% in the group II ( P = .067). Conclusion: Papillary thyroid cancer located in the isthmus showed a tendency to involve bilateral CLN. In conclusion, it is recommended that bilateral central compartment neck dissection is needed as an appropriate surgical option for papillary thyroid cancer with single nodule located in the isthmus.

Robotic Thyroidectomy via a Transaxillary Approach

Objective: Recently, various robotic surgical procedures have been performed, and most reports have proved that the application of robotic technology for surgery is technically feasible and safe. The feasibility and safety of robotic thyroid surgery was examined via transaxillary single port approach without gas insufflation. Method: The study included 109 consecutive patients with papillary thyroid cancer who underwent robot-assisted endoscopic thyroid surgery using a gasless transaxillary single port approach by a single surgeon (Y.W.K.) between May 2010 and August 2011 at the department of otorhinolaryngology, Yonsei University College of Medicine. Results: The console time for 50 hemithyroidectomy (HT) with ipsilateral central compartment neck dissection (CCND) was 45.67 min, and that of 59 total thyroidectomy (TT) with ipsilateral or bilateral CCND was 93.77 min. The amount of drainage was 194.07 mL, and the duration of drainage was 3.5 days. The hospital stay was 6.09 days. Mean primary tumor size was 6.58 mm. The average number of lymph nodes resected was 3.51 (range, 1-19). Temporary hypoparathyroidism encountered with 24 patients in the TT group (40.7%, 24/59). There were 5 cases of temporary recurrent laryngeal nerve injury and 12 of seromas. One case of temporary brachial plexus injury occurred due to arm positioning. Conclusion: The technique of robotic thyroid surgery using a gasless transaxillary single port approach is a feasible, safe, and effective method for selected patients with thyroid cancer. The authors suggest that application of robotic technology for endoscopic thyroid surgeries could overcome the limitations of conventional endoscopic surgeries in the surgical management of thyroid cancer.

Comparative study of robotic versus endoscopic thyroidectomy by a gasless unilateral axillo‐breast or axillary approach

Robotic thyroidectomy and conventional endoscopic thyroidectomy have not been thoroughly compared. In this study, we compared the potential advantages of robotic versus endoscopic thyroidectomy. We analyzed 218 consecutive patients who underwent endoscopic (105 cases) or robotic (113 cases) thyroidectomy using a gasless unilateral axillo-breast or gasless unilateral axillary approach. Because of the dexterity of robotic instruments and the improved surgical view, it was subjectively easier and took less time to perform a complete total thyroidectomy and central compartment neck dissection in robotic thyroidectomy. In the case of unilateral lobectomy, endoscopic and robotic thyroidectomy had quite similar surgical outcomes. Cosmetic satisfaction was excellent in both groups. In this series by a single surgeon, robotic thyroidectomy was superior to endoscopic thyroidectomy for performing total thyroidectomy and bilateral central compartment neck dissection. However, in terms of cost-effectiveness, endoscopic thyroidectomy was comparable to robotic thyroidectomy in patients who undergo unilateral lobectomy.

Biological characteristics and management of familial papillary thyroid carcinoma

To analyze the clinical biological characteristics and investigate the managements of familial papillary thyroid carcinoma (FPTC). Clinical data of 36 patients with PTC from 15 families were retrospectively analyzed compared with 95 control cases taken randomly from the patients with sporadic PTC diagnosed and treated in Tianjin Cancer Hospital between January 2010 and August 2011. Of the 36 patients with FPTC, 15 (41.7%) were ≥45 years old, 12 (33.3%) had bilateral carcinoma, 20 (55.6%) were multifocality, 27 (75.0%) had neck lymph node metastases, 17 (47.2%) coexisted thyroid benign tumors. Of the 95 patients with SPTC, 60 (63.2%) were ≥45 years old, 12(12.6%)had bilateral carcinomas, 21 (22.1%) were multifocality, 51 (53.7%) had neck lymph node metastases, and 26(27.4%)coexisted thyroid benign tumors. Of the 36 patients with FPTC, 22 (61.1%) underwent total thyroidectomy and 14 (38.9%) with unilateral thyroidectomy plus isthmusectomy, 3 (8.3%) received unilateral or bilateral lateral neck dissection and central compartment neck dissection (CND), 7 (19.4%) received unilateral or bilateral posterolateral neck dissection and CND, 6 (16.6%) received posterolateral neck dissection and bilateral CND, and 20 (55.6%) received unilateral or bilateral CND. Age at disease presentation of FPTC was younger than that of SPTC. FPTC has higher rates of multifocality and bilateral carcinoma coexisting with thyroid benign tumor than those of SPTC. It necessary to take family history in detail and to evaluate diseases before operation.

Clinical Efficacy of Sentinel Lymph Node Biopsy Using Methylene Blue Dye in Clinically Node-Negative Papillary Thyroid Carcinoma

Sentinel lymph node biopsy (SLNB) has recently been used to detect occult lymph node metastases. The aim of this study was to assess the feasibility and clinical efficacy of SLNB in the treatment of clinically node-negative papillary thyroid carcinoma. A total of 114 consecutive patients with clinically node-negative papillary thyroid carcinoma were enrolled and underwent SLNB. After injection of 1% methylene blue around the tumors, blue-stained sentinel lymph nodes (SLN) were collected from the central compartments. All the patients underwent total thyroidectomy with bilateral central compartment neck dissection after SLNB. SLN were identified in 84 (73.7%) of the 114 patients. Of these 84 patients, 24 (28.6%) had metastases in the SLN. Among the 60 patients who had no metastases in their SLN in frozen biopsy samples, seven had metastatic foci in their SLN in the permanent biopsy samples and six had metastases in their non-SLN samples. Central compartment lymph node metastases were detected in 11 of the 30 patients in whom SLN were not identified. Thus, the sensitivity, specificity, and positive and negative predictive values of SLNB were 64.9, 100, 100, and 78.3%, respectively. The false-positive and false-negative rates were 0 and 35.1%, respectively. The detection of SLN led to no major complications. SLNB using methylene blue in papillary thyroid carcinoma is a safe and technically feasible procedure. However, it is of limited use in the management of clinically node-negative papillary thyroid carcinoma because of low sensitivity and a high false-negative rate.

Patterns of Lateral Lymph Node Metastasis in Papillary Thyroid Cancer

Objective: Analyze the patterns and factors of lateral lymph node metastasis in papillary thyroid cancer (PTC) patients. Based on this, we can suggest the optimal surgical extent of neck dissection for PTC patients with lateral compartment lymph node metastasis. Method: From January 2000 to December 2009, the patient group consisted of 88 patients who underwent total thyroidectomy concomitant therapeutic neck dissection. A total of 86 (97.7%) patients confirmed as having PTC and lateral compartment neck metastasis by pathologic examination were enrolled this study. Results: A total of 86 patients underwent 100 lateral compartment neck dissection. Level IV was found to be the predominant site for lateral compartment lymph node metastasis (83%). Level III, Level II, and Level V were 65%, 54%, 17%, respectively. Level VI lymph node metastasis was found in 84.9% (73/86). Multiple level nodal metastasis was correlated with lymphovascular invasion of PTC. Skip metastasis was correlated with age. Conclusion: In PTC patients with lateral nodal invasion, total thyroidectomy concomitant bilateral central compartment neck dissection and ipsilateral lateral compartment neck dissection including Levels II-V may be the optimal treatment.

Central Compartment Neck Dissection for Thyroid Cancer: A Surgical Technique

Several professional societies have in the past few years joined forces to standardize and define terminology for central compartment neck dissection, with the objective of improving communication among professionals and encouraging a more uniform surgical approach to neck nodes. Precisely defining and describing a technique has the advantage of providing a basis for communication and for discussion. A basic technique should be reproducible with low morbidity and teachable to surgeons in training. We herein describe a basic technique for bilateral central compartment neck dissection for thyroid cancer.