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[Cervical lymph node metastasis in clinical N0 papillary thyroid carcinoma]
Dan-gui Yan1, Bin Zhang, Chang-ming An
1Department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
Summary
Papillary thyroid carcinoma often has occult lymph node metastasis in the neck, primarily in levels VI, III, IV, and II. Selective neck dissection of these levels is sufficient for clinical N0 cases.
Area of Science:
- Oncology
- Surgical Pathology
- Head and Neck Surgery
Background:
- Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy.
- Accurate staging of cervical lymph node metastasis is crucial for treatment planning in PTC.
- Clinical N0 (cN0) status in PTC requires detailed understanding of occult metastasis patterns.
Purpose of the Study:
- To investigate the patterns of cervical lymph node metastasis in cN0 papillary thyroid carcinoma.
- To evaluate the efficacy of surgical management strategies for lymph node involvement in cN0 PTC.
Main Methods:
- A cohort of 51 patients with cN0 PTC underwent neck lymph node dissection (53 sides).
- Sentinel lymph node (SLN) detection utilized lymphoscintigraphy, gamma probe, and blue dye techniques.
- Pathologic analysis mapped metastasis localization and correlated clinical factors with lateral neck metastasis.
Main Results:
- Occult and lateral neck metastasis rates were 77.4% and 58.5%, respectively.
- Central compartment metastasis of ≥3 nodes was the sole independent predictor of lateral neck metastasis.
- Metastasis distribution: Level VI (62.3%), Level III (52.8%), Level IV (30.2%), Level II (18.9%), Level V (0%).
Conclusions:
- Cervical occult lymph node metastasis in cN0 PTC predominantly affects levels VI, III, IV, and II.
- Selective neck dissection encompassing levels VI, III, IV, and II is adequate for cN0 PTC.
