Korean J Endocr Surg.  2011 Sep;11(3):164-168. 10.0000/kjes.2011.11.3.164.

Pattern of Lateral Neck Metastasis and Predictors of Level V Metastasis in Papillary Thyroid Carcinoma

• Kim T
• Lee Y
• Park H
• Chung Y
• Ku S

• KMID: 2375377
• DOI: http://doi.org/10.0000/kjes.2011.11.3.164

Abstract

PURPOSE
Cervical lymphadenectomy is frequently performed in patients with lateral cervical lymph node metastasis to improve regional control of disease. However, there is controversy regarding appropriate levels of the neck that need to be dissected. In particular, the routine dissection of level V remains an annoying and time consuming procedure due to the injury of the spinal accessory nerve.
METHODS
To identify clinical and pathological predictors of cervical node metastases to level V in papillary thyroid carcinoma, we analyzed 42 patients who underwent modified radical neck dissection (MRND), which were separately performed by each strict anatomical level. Five patients underwent both MRND, 29 patients received total thyroidectomy with central neck node dissection and MRND at the time of initial operation. Thirteen patients underwent MRND later when lateral neck metastases were found at the follow-up after total thyroidectomy with central neck node dissection.
RESULTS
In our series, 11.9% of neck specimens harbored metastatic thyroid carcinoma at level V. The metastatic rate of level II, III, and IV was 54.7%, 85.7%, and 64.2%, respectively. The presence of level V metastases was not significantly associated with level II, III metastases, age, sex, and histopathologic findings. But, it seemed to be associated with level IV metastases if the proportion of metastasis of level IV exceeded 50%.
CONCLUSION
Cervical node metastasis seems to be associated with level IV metastases if the proportion of metastasis of level IV exceeds 50%.

Keyword

Papillary thyroid carcinoma; Lateral neck node metastasis; Modified radical neck node dissection; Level V metastases

MeSH Terms

Accessory Nerve
Follow-Up Studies
Humans
Lymph Node Excision
Lymph Nodes
Neck Dissection
Neck*
Neoplasm Metastasis*
Thyroid Gland*
Thyroid Neoplasms*
Thyroidectomy

Figure

• 

  Fig. 1 The six Levels and six sublevels of the neck according to the 2002 neck dissection classification update.(22)

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