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Anatomic Variability of the Upper Mediastinal Lymph Node Level VII.

Dana M Hartl1, Ingrid Breuskin2, Haïtham Mirghani2

  • 1Department of Head and Neck Oncology, Thyroid Surgery Unit, Institut de Cancérologie Gustave Roussy and Paris-Sud University, 114, Rue Edouard Vaillant, 94805, Villejuif Cedex, France. dana.hartl@gustaveroussy.fr.

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Summary

Lymph node level VII is often involved in thyroid cancer metastasis. This study found level VII is accessible via standard neck incisions and typically small, suggesting its distinction from level VI may not be critical in surgery.

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Area of Science:

  • Oncology
  • Surgical Anatomy
  • Head and Neck Surgery

Background:

  • Lymph node level VII, located between the sternal notch and innominate artery, is a common site for thyroid cancer metastases.
  • Accurate anatomical understanding is crucial for effective surgical management of thyroid cancer.

Purpose of the Study:

  • To determine the dimensions of lymph node level VII in patients undergoing thyroid cancer surgery.
  • To assess the accessibility of level VII through a standard neck incision.

Main Methods:

  • Measurements of the cranial-caudal extent of level VII were taken in 101 patients undergoing central neck dissection for thyroid cancer.
  • The distance between the sternal notch and the innominate artery was recorded.
  • Level VII accessibility via a horizontal neck incision was evaluated.

Main Results:

  • Level VII was accessible via a standard horizontal neck incision in all patients.
  • The mean distance of level VII was 3.5 mm below the sternal notch, with a maximum of 35 mm below.
  • Level VII was absent in 49% of patients and measured less than 25 mm caudal to the sternal notch in 95%.

Conclusions:

  • Lymph node level VII is consistently accessible through a standard neck incision.
  • The small size and frequent absence of level VII suggest its distinction from level VI may not be clinically significant in thyroid cancer surgery.