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

Area of Science:

• Oncology
• Surgical Oncology
• Head and Neck Surgery

Background:

• The optimal extent of lateral neck dissection for papillary thyroid cancer (PTC) with nodal metastases is debated.
• Specifically, the necessity of level V lymphadenectomy in clinically node-negative patients requires clarification.

Purpose of the Study:

• To determine indications for omitting level V lymphadenectomy in patients with papillary thyroid cancer.
• To evaluate the risk of level V metastases based on findings in other neck levels.

Main Methods:

• Retrospective review of 70 PTC patients undergoing therapeutic lateral neck dissection (levels II-V).
• Exclusion of patients with clinically positive level V nodes.
• Histologic analysis of lymph node metastasis by individual neck levels.

Main Results:

• Histologically positive nodes were found in 49% (level II), 74% (level III), and 69% (level IV).
• Occult metastases in level V occurred in 16% of patients, always with concurrent level IV involvement.
• Level V metastases were never isolated and were associated with multilevel (II, III, IV) disease.

Conclusions:

• Level V lymphadenectomy can be omitted in PTC patients when level IV nodes are negative on frozen section or ultrasonography.
• This approach avoids unnecessary morbidity associated with extensive neck dissections.