Extent of lateral neck dissection for papillary thyroid microcarcinomas

Lee, Joon‐Hyop; Chun, Yong Soon; Chung, Yoo Seung

doi:10.1002/hed.25570

Cited by 5 publications

(10 citation statements)

References 15 publications

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“…Compared with levels II, III, and IV, the overall incidence of LLNM in level V was much lower, ranging from 4.5 to 33.9%, as previously reported (14, 15, 23, 24). In our study, the overall and occult metastasis rates of level V lymph nodes were 21.4 and 6.4%, which were also the lowest among all lateral lymph node levels.…”

Section: Discussionsupporting

confidence: 76%

“…For PTC larger than 1 cm, clinical benefits and risks of routine level V dissection (LVD) have been reported even though the results are still controversial (9–11). Although lateral neck compartment involvement is less common in PTMC patients, whether the LLNM pattern of PTMC is the same as that of PTC with >1 cm tumors is still debatable (12–14). Moreover, PTMC patients with LLNM exhibit more frequent multifocality and skip metastasis and less central lymph node metastasis (CLNM) than do PTC patients with tumors larger than 1 cm (14, 15).…”

Section: Introductionmentioning

confidence: 99%

“…Although lateral neck compartment involvement is less common in PTMC patients, whether the LLNM pattern of PTMC is the same as that of PTC with >1 cm tumors is still debatable (12–14). Moreover, PTMC patients with LLNM exhibit more frequent multifocality and skip metastasis and less central lymph node metastasis (CLNM) than do PTC patients with tumors larger than 1 cm (14, 15). Whether level V lymph nodes should be routinely dissected in PTMC patients with LLNM remains unknown because of the lack of evidence.…”

Section: Introductionmentioning

confidence: 99%

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Routine Lateral Level V Dissection May Not Be Necessary for Papillary Thyroid Microcarcinoma With Lateral Lymph Node Metastasis: A Retrospective Study of 252 Cases

et al. 2019

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Background: Lateral lymph node metastasis (LLNM) is associated with distant metastasis, locoregional recurrence and cancer-specific mortality, although the prevalence of LLNM among patients with papillary thyroid microcarcinoma (PTMC) is relatively low. The potential benefits and risks of routine lateral level V dissection (LVD) for PTMC with LLNM have not been previously investigated. Methods: A total of 6,880 consecutive PTMC patients who underwent initial surgery at the First Hospital of Jilin University from January 2009 to July 2017 were retrospectively analyzed. A total of 252 N1b PTMC patients were enrolled in our study. Results: The overall and occult metastasis rates in level V lymph nodes were 21.4 and 6.4%, respectively. Patients with N1b PTMC who received LVD did not show a significantly lower disease-free survival (DFS) than that of patients who did not receive LVD [hazard ratio = 1.11 (CI 0.38–3.21); p = 0.85]. Meanwhile, LVD simultaneously increased the hospital stay and cost ( p = 0.03; 0.02). Multivariate logistic regression analysis revealed that 3-level simultaneous metastasis in the lateral neck was an independent risk factor for level V metastasis [odds ratio = 8.6 (CI 1.42–51.72); p = 0.02]. Conclusions: Because of the low metastasis rate in level V lymph nodes, the lack of benefit for recurrence, the longer hospital stay and the higher cost associated with LVD, N1b PTMC patients without clinical level V metastasis may not need to undergo routine dissection. Prophylactic LVD may be recommended only for patients with N1b PTMC with 3-level simultaneous metastasis.

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Routine Lateral Level V Dissection May Not Be Necessary for Papillary Thyroid Microcarcinoma With Lateral Lymph Node Metastasis: A Retrospective Study of 252 Cases

et al. 2019

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“…An ongoing debate concerns the optimal extent of therapeutic LND in the management of N1b PTMC patients ( 2 , 19 – 21 ). Considering the excellent prognosis and potential complications associated with surgery, the extensive LND is not well recognized nor yet accepted in the clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…Papillary thyroid microcarcinoma (PTMC) generally presents an indolent disease course with a good outcome. Recently, its incidence worldwide has increased dramatically, largely due to the development of high-resolution ultrasonography and improved health awareness (1)(2)(3). However, some PTMCs show aggressive behavior, such as gross extrathyroidal extension (ETE) and/or multiple-level metastasis at initial diagnosis, which indicates a high risk of locoregional recurrence and poor disease-free survival (3,4).…”

Section: Introductionmentioning

confidence: 99%

Management of Lateral Multiple-Level Metastasis in N1b Papillary Thyroid Microcarcinoma

et al. 2020

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Background: The optimal extent of therapeutic lateral neck dissection (LND) in the management of N1b papillary thyroid microcarcinoma (PTMC) is still under debate in clinical practice. In this light, our study aims to explore the incidence, patterns, and predictive factors of the lateral multiple-level metastasis in N1b PTMC patients. Methods: The clinical records of 142 patients diagnosed with N1b PTMC who underwent therapeutic LND from July 2015 to November 2018 at our institution were retrospectively reviewed. Univariate and multivariate analyses were conducted to examine the predictive factors associated with lateral multiple-level metastasis. The recurrence-free survival was analyzed and confirmed by Kaplan–Meier plots and log-rank test. Results: The overall frequency of lateral multiple-level metastasis was 50.7% in N1b PTMC patients, and two-level to four-level simultaneous metastasis were present in 26.8, 17.6, and 6.3% patients, respectively. Extrathyroidal extension (ETE) (OR = 5.79, 95% CI, 1.36–24.59; P = 0.017) and the central metastatic lymph node ratio (CLNR) with values equal or higher than 0.61 (OR = 6.18, 95% CI, 2.53–15.09; P < 0.001) served as independent predictors of multiple-level metastasis in N1b PTMC patients. Moreover, locoregional recurrence was significantly higher in the selective neck dissection (SND) group compared to the modified radical neck dissection (MRND) one (HR = 3.65, 95% CI, 1.11–12.00; P = 0.03). Conclusion: Our results show that the lateral multiple-level metastasis was relatively common, and we suggest MRND to be considered for N1b PTMC patients with ETE or CLNR equal or higher than 0.61.

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Prediction of level V metastases in papillary thyroid microcarcinoma: a single center analysis

Wang¹,

Bai²,

Ouyang³

et al. 2020

Gland Surg

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Background: The rate of level V metastases is significantly low and the necessity of routine level V dissection for papillary thyroid microcarcinoma (PTMC) with clinically lateral lymph node metastasis (LNM) is still controversial.Methods: This study enrolled 114 consecutive PTMC patients with clinically suspected lateral LNM (N1b) who underwent modified radical neck dissection (levels II to V) at Xiangya Hospital of Central South University from September 2016 to July 2019. Univariate and multivariate analyses were performed to investigate the predictive factors of level V metastasis. The area under the receiver operating characteristic (ROC) curve (AUC), accuracy, specificity and sensitivity were used to determine the predictive value. Results:The overall and occult rate of level V metastasis were 29.82% (34/114) and 7.02% (8/114), respectively. Univariate analysis showed that level V metastasis was significantly associated with gross extrathyroidal extension (ETE), level IV metastasis and 2-level simultaneous metastasis (all P<0.05).Gross ETE (OR =11.916, 95% CI, 1.404-102.19; P=0.023) and level IV metastasis (OR =8.497, 95% CI, 2.119-34.065; P =0.03) served as independent predictors of level V metastasis in N1b PTMC patients. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of gross ETE and level IV metastasis in predicting the level V metastasis were 25.3% vs. 82.4%, 97.5% vs. 73.8%, 82.69% vs. 76.32%, 80% vs. 57.04% and 75% vs. 90.77%, respectively. The AUC of gross ETE was lower than level IV metastasis (0.605 vs. 0.781, P=0.041).Conclusions: Routine level V dissection is necessary in N1b PTMC patients with level IV metastasis or gross ETE. Compared with gross ETE, level IV metastasis is superior in predicting level V metastasis.

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Extent of lateral neck dissection for papillary thyroid microcarcinomas

Cited by 5 publications

References 15 publications

Routine Lateral Level V Dissection May Not Be Necessary for Papillary Thyroid Microcarcinoma With Lateral Lymph Node Metastasis: A Retrospective Study of 252 Cases

Routine Lateral Level V Dissection May Not Be Necessary for Papillary Thyroid Microcarcinoma With Lateral Lymph Node Metastasis: A Retrospective Study of 252 Cases

Management of Lateral Multiple-Level Metastasis in N1b Papillary Thyroid Microcarcinoma

Prediction of level V metastases in papillary thyroid microcarcinoma: a single center analysis

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