[Clinical evaluation of extended neck differentiated thyroid carcinoma]

In some patients with advanced differentiated thyroid carcinoma, an upper mediastinal dissection is recommended. Both 17 primary and 6 non-primary patients who had undergone an upper mediastinal dissection in Shinshu University Hospital, from 1984 to 1987, were surveyed. We also studied 198 patients who had been performed a modified radical neck dissection from 1984 to 1986. In the 17 primary cases, 6 (35%) had positive nodes in the upper mediastinum (M group), and 11 (65%) negative (NM group). And we analysed these two groups. In addition, 5 non-primary cases and 198 patients were analyzed in terms of the nodal metastatic status of the tumor-free side. From these results, we conclude the indication of mediastinal dissection for thyroid carcinoma as follows: (1) positive lymph node is suspected in the upper mediastinum by the study of CT or 201thallium scintigram. (2) nodal metastases are suspected in the deep cervical location of the tumor-free side. (3) a male patient whose age is younger than 50, and tumor is located in the left lobe and its size is larger than 3.0 cm.