Pattern of cervical lymph node metastases from papillary carcinoma of the thyroid

The management of cervical metastases from papillary thyroid carcinoma ranges from selective removal (berry picking) to a formal comprehensive neck dissection. Without a clear understanding of the distribution of nodes at risk, the formulation of strategies on how best to manage the clinically positive neck is difficult. This study reports on observations made in patients who underwent a therapeutic comprehensive neck dissection for metastatic papillary thyroid carcinoma by defining lymph node involvement with respect to neck level.

The clinical records and pathological reports of 75 consecutive patients who underwent a neck dissection for cervical metastases from papillary thyroid carcinoma over a 10-year period were reviewed. All dissections were therapeutic in nature, being performed in patients with clinically positive neck nodes. Eighty neck dissection specimens were obtained and analyses were divided into three groups by virtue of the type of dissection performed: a bilateral comprehensive neck dissection, unilateral radical neck dissection and unilateral comprehensive neck dissection. The relative involvement of cervical nodes was analysed with reference to node levels I-V.

Patients in the anterolateral group (levels II, III and IV) were at greatest risk of metastatic disease, with level III nodes consistently the most frequently involved, across all treatment groups. Only three patients exhibited level I involvement, all of whom had extensive neck disease involving all or almost all neck levels.

The majority of patients present with multiple level node disease, with the anterolateral group at greatest risk. A comprehensive neck dissection is recommended for all patients with palpable cervical lymphadenopathy.