Prophylactic Lymphadenectomy of Neck Level II in Clinically Node-Positive Papillary Thyroid Carcinoma

Background The purpose of this study was to examine the frequency, pattern, and predictive factors associated with occult level II lymph node (LN) metastases in papillary thyroid carcinoma (PTC) patients with clinically metastatic lymph nodes in the lateral neck (level III, IV, and/or V) by preopera...

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Bibliographic Details
Published in:Annals of surgical oncology 2010-06, Vol.17 (6), p.1637-1641
Main Authors: Koo, Bon Seok, Seo, Sung-Tae, Lee, Gun-Ho, Kim, Jin-Man, Choi, Eun Chang, Lim, Young Chang
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Carcinoma, Papillary - diagnostic imaging
Carcinoma, Papillary - pathology
Carcinoma, Papillary - surgery
Endocrine Tumors
Female
Humans
Lymph Nodes - diagnostic imaging
Lymph Nodes - pathology
Lymphatic Metastasis - prevention & control
Male
Medical Records
Medicine
Medicine & Public Health
Middle Aged
Multivariate Analysis
Neck Dissection
Neoplasm Staging
Odds Ratio
Oncology
Predictive Value of Tests
Preoperative Care
Prognosis
Retrospective Studies
Surgery
Surgical Oncology
Thyroid Neoplasms - diagnostic imaging
Thyroid Neoplasms - pathology
Thyroid Neoplasms - surgery
Thyroidectomy
Treatment Outcome
Ultrasonography
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Summary:Background The purpose of this study was to examine the frequency, pattern, and predictive factors associated with occult level II lymph node (LN) metastases in papillary thyroid carcinoma (PTC) patients with clinically metastatic lymph nodes in the lateral neck (level III, IV, and/or V) by preoperative ultrasonography. Methods We retrospectively reviewed the medical records of 52 PTC patients with clinically positive neck lymph nodes in level III, IV, and/or V based on preoperative ultrasonography, who underwent therapeutic lateral neck dissection (ND) (level II–V) between March 2004 and October 2009. All patients had no suspicion of clinically positive neck nodes in level II. Histopathological analysis of neck specimens according to each node level of the neck was performed, with special attention given to level II. Results Forty-two (81%), 41 (79%), and 6 (12%) patients had histologically positive lymph nodes in level III, IV, and V, respectively. Occult metastases in level II were observed in ten (19%) patients. Patients without suspicious positive LNs in both neck level III and IV by preoperative ultrasonography, and patients without pathologic LN metastases in level III, had no occult LN metastases occurrence to level II. Based on multivariate analysis, presence of more than four metastatic LNs was an independent predictive factor for occult level II metastases [ P  = 0.022, odds ratio (OR) = 7.738]. Conclusions Prophylactic level II LN dissection may be omitted in PTC patients with clinically positive neck nodes if suspicious positive lymph nodes in level III are absent during preoperative ultrasonography.
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-010-0958-7