Is Routine Dissection of Level II‐B and V‐A Necessary in Patients with Papillary Thyroid Cancer Undergoing Lateral Neck Dissection for FNA‐Confirmed Metastases in Other Levels

Agarwal, Shikha; Chand, Gyan; Agarwal, Amit; Mishra, Anjali; Agarwal, Gaurav; Verma, Ashok Kumar; Mishra, Saroj Kanta

doi:10.1007/s00268-010-0399-2

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(2 citation statements)

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“…Considering the excellent prognosis and potential complications associated with surgery, the extensive LND is not well recognized nor yet accepted in the clinical practice. Several studies ( 22 , 23 ) recommend conservative LND for N1b PTMC; however, it may increase the regional recurrence rate and decrease the disease-free survival. Therefore, decisions regarding a rational extent of the therapeutic LND should be considering the balance between the functional outcome and the oncologic safety.…”

Section: Discussionmentioning

confidence: 99%

“…Next, we explored the prognostic impact of therapeutic LND on locoregional recurrence. Many studies have reported the association between the recurrence risk and the extent of LND, but the exact extent of the LND from a prophylactic LND to a comprehensive neck dissection of all lateral neck lymph nodes have not been well understood ( 11 , 23 , 31 , 32 ). A systematic review and meta-analysis ( 19 ) have revealed that the extent of LND may not change the rate of recurrence and recommended SND for N1b PTC patients without any other risk factors.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%