Occult lymph node metastases in neck level V in papillary thyroid carcinoma

Lim, Young Chang; Choi, Eun Chang; Yoon, Yeo-Hoon; Koo, Bon Seok

doi:10.1016/j.surg.2009.09.002

« Previous Next »Surgery
Volume 147, Issue 2 , Pages 241-245, February 2010

Occult lymph node metastases in neck level V in papillary thyroid carcinoma

Young Chang Lim, MD
- Department of Otorhinolaryngology-Head & Neck Surgery, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
Eun Chang Choi, MD
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
Yeo-Hoon Yoon, MD
- Department of Otolaryngology-Head and Neck Surgery, Cancer Research Institute, Research Institute for Medical Sciences, Chungnam National University College of Medicine, Daejeon, Korea
Bon Seok Koo, MD
- Department of Otolaryngology-Head and Neck Surgery, Cancer Research Institute, Research Institute for Medical Sciences, Chungnam National University College of Medicine, Daejeon, Korea
- Reprint requests: Bon Seok Koo, MD, Department of Otolaryngology, Head and Neck Surgery, Chungnam National University Hospital, 640 Daesa-Dong, Chung-Gu, Daejeon 301-040, Republic of Korea.

Accepted 4 September 2009. published online 12 November 2009.

Background

The extent of lateral neck dissection for clinically evident nodal metastases in the lateral neck in a patient with papillary thyroid cancer (PTC) continues to remain controversial.

Methods

We reviewed retrospectively the medical records between March 2005 and March 2008 of 70 patients with PTC who underwent therapeutic lateral neck dissections (level II–V) to establish indications for omission of a level V lymphadenectomy. No patient in the study had a clinically positive level V lymph node. Neck dissection specimens were obtained for histologic analysis for node metastasis with respect to the individual neck levels.

Results

Thirty-four (49%), 52 (74%), and 48 (69%) patients had histologically positive lymph nodes in levels II, III, and IV, respectively. Occult metastases in level V were observed in 11 (16%) patients. Isolated positive level V lymph nodes were never found, while all patients with positive level V lymph nodes had simultaneous positive level IV lymph nodes. In addition, there was no instance of a pathologically positive lymph node in level V without a suspicious metastatic lymph node in level IV by preoperative ultrasonography. In multivariate analysis, simultaneous multilevel involvement (level II, III, and IV) of lymphatic metastases was associated with level V metastasis.

Conclusion

Level V lymphadenectomy may be omitted in the treatment of PTC patients if positive nodes are not found on histologic exam (frozen section analysis) or by ultrasonography in level IV.