Sonographically-directed neck dissection for recurrent thyroid carcinoma

To determine the effectiveness of sonographically-directed compartmental neck dissection for recurrent differentiated thyroid carcinoma as confirmed by ultrasound surveillance and thyroid-specific biochemical markers.

Retrospective chart review.

Retrospective cohort study of 18 patients with sonographically localized and pathology-confirmed recurrent differentiated thyroid carcinoma. Fifteen patients chose to undergo compartmental neck dissection by a single surgeon. Surgery involved central compartment (level VI) or functional lateral neck dissection (level II-IV+/-V). Three patients declined surgery despite proven recurrent lymph node disease.

All 18 patients started out with sonographic evidence of recurrent lymph node disease. Preoperative thyroglobulin or thyroglobulin antibody levels were positive in 17 of 18 patients (94%). Postoperatively, all 15 patients who underwent compartmental lymph node dissections had no sonographic evidence of lymph node disease. Of the 14 patients with preoperative positive thyroglobulin or thyroglobulin antibody levels, 9 patients converted to negative levels (64%). Furthermore, two of four patients (50%) converted to thyroglobulin antibody negative status after surgery. All three patients who declined surgery had persistently detectable sonographic nodal disease in addition to positive thyroglobulin and/or thyroglobulin antibody levels (100%). Surgical complications were minimal and self-limited as no patient experienced permanent cranial nerve deficits.

Ultrasound-directed cranial nerve sparing compartmental lymph node dissection results in no sonographically detectable cervical lymph node disease and undetectable basal thyroglobulin or thyroglobulin antibody levels in the majority of patients with low morbidity.