Patterns of Cervical Lymph Node Metastases in Primary and Recurrent Papillary Thyroid Cancer

Abstract

The incidence of thyroid cancer is rising in the United States with papillary thyroid cancer (PTC) being the most common type. We performed a retrospective study of 49 patients with PTC who underwent 57 lateral neck dissections (NDs). The extent of NDs varied, but 29 of 57 (51%) consisted of levels II–V. Twelve of 57 (21%) NDs consisted of levels I–V. Twelve of 57 (21%) NDs consisted of levels II–IV. One of 57 (1.8%) necks involved only levels I–IV. One of 57(1.8%) necks involved only levels I–V. One of 57(1.8%) necks involved only levels III–V. Two (3.5%) double-level (III–IV) neck surgeries were also performed. Metastatic PTC adenopathy was confirmed pathologically in 2%-level-I, 45%-level-II, 57%-level-III, 60%-level-IV, and 22%-level-V necks. Level-V was positive in 21% of primary and 24% of recurrent groups (P = 0.76). Comparing primary and recurrent disease, there was no difference in nodal distribution or frequency for levels I, II, III, and V. Level-IV was more common in the recurrent cases (P = 0.05). Based on the pathologic distribution of nodes, dissection should routinely include levels II–IV and extend to level-V in primary and recurrent cases. Our data does not suggest routine dissection of level-I.

Metastatic papillary thyroid cancer with lateral neck disease: Pattern of spread by level

“…Although previous recommendations regarding the management of the lateral neck in metastatic PTC vary widely, there seems to be some consensus in the most recent literature, with which our data and recommendations coincide. Recent studies from single‐center high volume institutions have advocated for routine excision of levels II to V . The Triological Society Best Practice guidelines published in 2010 recommend a selective neck dissection with excision of levels IIa to Vb with or without the inclusion of levels IIb and Va .…”

“…Although previous recommendations regarding the management of the lateral neck in metastatic PTC vary widely, there seems to be some consensus in the most recent literature, with which our data and recommendations coincide. Recent studies from single-center high volume institutions have advocated for routine excision of levels II to V. [15][16][17] The Triological Society Best Practice guidelines published in 2010 recommend a selective neck dissection with excision of levels IIa to Vb with or without the inclusion of levels IIb and Va. 12 Based on a nonsystematic review, the ATA's recent consensus review on lateral neck dissection in differentiated thyroid cancer similarly advocate for a comprehensive neck dissection of at least nodal levels IIa, III, IV, and Vb. 13 Lymph node metastasis from PTC to level V ranges from 8% to 53%.…”

Pattern of Primary Thyroid Malignancy in a Tertiary Care Hospital

“…Thyroid cancer is the most common of all endocrine malignancies, accounting for 87% of all endocrine gland tumors. Clinically diagnosed thyroid cancer accounts for 6.1% of all newly diagnosed cases of cancer in Saudi Arabia and are ranked fourth in males and second in females 10 .…”

The Clinical Significance of the Right Para-Oesophageal Lymph Nodes in Papillary Thyroid Cancer

“… 1 2 Over 90% of all thyroid carcinomas exhibit a relatively indolent clinical course, with excellent prognosis. 1 3 In contrast, cervical lymph node metastasis has been observed in 30% to 90% of patients with papillary thyroid cancer (PTC) and has been shown to be closely associated with persistent and recurrent disease. 1 4 5 6 7 8 9 Most metastatic sites in patients with PTC are located in central compartment lymph nodes, 10 11 and central lymph node dissection has been found to reduce loco-regional recurrence and improve disease-free survival in patients with PTC.…”