Updated definition of level VI lymph node classification in the neck

Lallemant, Benjamin; Reynaud, Christophe; Alovisetti, Caroline; Debrigode, C.; Ovtchinnikoff, S.; Chapuis, H; Lallemant, J. G.

doi:10.1080/00016480600806299

Cited by 12 publications

(8 citation statements)

References 29 publications

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“…SMLNs are categorized as level VI LNs by an imaginary line, not an anatomical barrier. SMLNs are directly connected to the lymphatic chain of the central compartment, and metastatic PTC could pass through the arbitrary limit between these regions[ 2 ]. The suggested mechanism of SMLN metastasis of thyroid carcinoma is downward lymphatic drainage from CND by gravity and direct extension of the thyroid tumor into the superior mediastinum[ 1 , 11 – 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Superior mediastinal lymph nodes (SMLNs) at level VI are bordered at only by an imaginary line, not by an anatomical barrier [ 1 , 2 ]. It is suspected that, when metastasis presents in neighboring pretracheal or paratracheal lymph nodes (LNs), the possibility of SMLN metastasis might increase in papillary thyroid carcinoma (PTC) patients.…”

Section: Introductionmentioning

confidence: 99%

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Predictive Factors of Superior Mediastinal Nodal Metastasis from Papillary Thyroid Carcinoma—A Prospective Observational Study

et al. 2016

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ObjectivesThe purpose of this study was to demonstrate the incidence rates and predictive factors of superior mediastinal lymph node (SMLN) metastasis in PTC (papillary thyroid carcinoma) patients.MethodsA prospective observational study was performed between January 2009 and January 2011. PTC patients who had tumors with a maximal diameter greater than 1 cm and clinically negative SMLNs were included in this study. Finally, a total of 217 patients who underwent total thyroidectomy with central compartment neck dissection (CND) and elective superior mediastinal lymph node dissection (SMLND), with or without modified radical neck dissection (MRND) and revisional CND, were included.ResultsOccult SMLN metastasis was present in 15.7% (34/217). Cytological classifications of tumor, BRAFV600E mutation, Tumor size, T-stage, perithyroidal extension, lymphovascular invasion, multifocality, and paratracheal pN(+) were not predictive of SMLN metastasis (P > .05), while revision surgery, pretracheal pN(+), and multiple lateral pN(+) were associated with SMLN metastasis. There were no major complications related to SMLND. Transient and permanent hypoparathyroidism was observed in 69 cases (31.8%) and 8 cases (3.6%), respectively.ConclusionsDespite clinically negative SMLN in preoperative evaluation, SMLN metastasis can be predicted for patients with a PTC tumor size larger than 1 cm, pretracheal LN metastasis, multiple lateral metastasis, and revisional surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predictive Factors of Superior Mediastinal Nodal Metastasis from Papillary Thyroid Carcinoma—A Prospective Observational Study

et al. 2016

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“…The inferior limit of PTLND was mostly described as: as far inferior into the superior mediastinum as possible, through the cervical approach, which may to lead to confusion as to whether or not PTLND encompasses SMLNs. Lallemant et al [12] proposed an updated definition of PTLN. In this report, they also discussed the definition of the SMLNs, which is often mistaken for level VI.…”

Section: Discussionmentioning

confidence: 99%

Elective superior mediastinal dissection for laryngeal carcinoma involving subglottis

Doğan¹,

Aslıer²,

Çetinayak³

et al. 2014

Acta Oto-Laryngologica

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SMM was found in 3 of 45 (6.6%) patients who underwent ESMD. The PR rate was higher in patients with SMM (66.7%) than in patients without SMM (9.5%) and the presence of SMM was significantly related to PR (p = 0.043) in univariate analysis. However, this relationship was not preserved in multivariate analysis. The 3- and 5-year survival rates of patients with SMM were lower (both 66.7%) than patients without SMM (83.3% and 76.2%, respectively), but decreased survival rates did not differ statistically from the survival rates of 42 patients without SMM.

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“…Usually a PTLN dissection is performed in advanced laryngeal and hypopharyngeal carcinomas with subglottic involvement [8,12]. It still remains to be identiWed in which patients PTLN dissection is really indicated [9]. Therefore, for clinical decision making and counseling it is important to know that even bilateral PTLN dissection does not contribute to the risk of development of hypothyroidism after treatment of laryngeal or hypopharyngeal cancer.…”

Section: Discussionmentioning

confidence: 99%

“…In advanced laryngeal and hypopharyngeal carcinoma paratracheal lymph node (PTLN) dissection is frequently performed [9]. The reported incidence of PTLN metastases varies between 9 and 36% depending on the site and stage of the primary tumor [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Paratracheal lymph node dissection does not negatively affect thyroid dysfunction in patients undergoing laryngectomy

Galbo

Bree

Kuik

et al. 2009

Eur Arch Otorhinolaryngol

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The aim of this retrospective study was to evaluate the prognostic signiWcance of paratracheal lymph node dissection including hemithyroidectomy for the development of hypo(para)thyroidism. From 1990From to 2004 patients with a carcinoma of the larynx or hypopharynx who underwent paratracheal lymph node dissection were selected. Data of 137 patients (23 women, 114 men) were analyzed. Hundred patients were tested on thyroid function. Patient, tumor and treatment characteristics were noted including age, gender, site, TNM stage and details of surgery, radiotherapy and chemotherapy. Seventy percent of the tested patients had hypothyroidism (36% clinical, 34% subclinical); 33% had hypoparathyroidism. All patients with hypo(para)thyroidism underwent various lymph node treatment modalities. For the various treatment combinations, no increase of hypo(para)thyroidism was found if a bilateral paratracheal lymph node dissection was performed. The incidence of hypo(para)thyroidism after laryngectomy in combination with hemithyroidectomy, neck dissection and paratracheal lymph node dissection is high. An additional risk of paratracheal dissection for the development of hypo(para)thyroidism could not be shown.

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Updated definition of level VI lymph node classification in the neck

Cited by 12 publications

References 29 publications

Predictive Factors of Superior Mediastinal Nodal Metastasis from Papillary Thyroid Carcinoma—A Prospective Observational Study

Predictive Factors of Superior Mediastinal Nodal Metastasis from Papillary Thyroid Carcinoma—A Prospective Observational Study

Elective superior mediastinal dissection for laryngeal carcinoma involving subglottis

Paratracheal lymph node dissection does not negatively affect thyroid dysfunction in patients undergoing laryngectomy

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