The Patterns of Lateral Neck Node Involvement in Papillary Thyroid Carcinoma

Chung, Woung Youn; Seo, Jin Hak; Park, Cheong Soo

Abstract

PURPOSE: We performed this study to identify the patterns of lateral neck node involvement and to define the appropriate method of neck node dissection in papillary thyroid carcinoma. MATERIAL AND METHODS: One hundred seventy one patients who had undergone radical neck dissection for lateral cervical lymph node metastasis of papillary thyroid cancer from January 1986 to December 1995 were analyzed retrospectively. Total operations were 178 cases and total radical neck dissections were 206 cases (bilateral in 28 cases, unilateral in 150 cases). Of these 206 cases, group I (170 cases, 82.5%) who had undergone comprehensive radical neck dissection or modified radical neck dissection and group II (36 cases, 17.5%) who had undergone jugular neck dissection were studied.
RESULTS
In group I, the most prevalent site of lymph node metastases was level III, followed by level II, IV, V and I. The 158 cases of group I in which nodes in the posterior triangle of the neck were not palpable preoperatively, were divided into five groups, 0, 1, 2, 3 and 4 or more, according to the number of clinically positive internal jugular nodes. The incidence of microscopically positive nodes in level V was significantly lower in the groups of one or less palpable internal jugular nodes (p=0.0007). In the 60 of 158 cases with the evaluable CT scans of the neck, the incidence of microscopically positive nodes in level V was significantly lower in the groups of two or less positive nodes on CT scan (p=0.0001). And, there were no significant differences in the incidence of recurrence, sites of recurrence, distant metastases, mortality between Group I and Group II.
CONCLUSION
The modified radical neck dissection might be justified in most papillary thyroid cancer patients with clinically positive lateral neck nodes. However, in patients with only one or less palpable node and two or less positive nodes on CT scan along the jugular lymphatic chains but negative in level V, it appears to be beneficial to perform a jugular neck dissection in reducing cosmetic disfigurement and preserving function.