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Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma
Published on: September 15, 2023
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Level I lymph node involvement in patients with N1b papillary thyroid carcinoma: a prospective study.
Ahmad M Eweida1,2, Mahmoud F Sakr3, Yasser Hamza3
1Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt. ahmad.eweida@bgu-ludwigshafen.de.
Summary
Papillary thyroid carcinoma (PTC) level I lymph node metastasis is predicted by multiple affected levels and extranodal invasion. Level I dissection may benefit selected N1b PTC patients with these factors.
Area of Science:
- Oncology
- Head and Neck Surgery
- Surgical Pathology
Background:
- Retrospective studies lack consensus on predictors for papillary thyroid carcinoma (PTC) lymph node (LN) metastasis, particularly in level I.
- Predictive factors for level I LN involvement in N1b stage PTC remain unclear, impacting surgical strategy.
Purpose of the Study:
- To prospectively determine the incidence of level I LN metastasis in N1b PTC patients.
- To identify clinicopathological predictors associated with level I LN involvement in this patient cohort.
Main Methods:
- Prospective study of 30 consecutive N1b stage PTC patients undergoing neck dissection (ND) including level I.
- Analysis of the relationship between level I LN metastasis and clinicopathological variables, including number of affected LN levels and extranodal invasion.
Main Results:
- Level I LN metastasis was found in 14% of specimens.
- Significant predictors for level I involvement included multiple affected lymph node levels (p=0.003) and macroscopic extranodal invasion (p=0.04).
- No significant association was found with gender, age, tumor size, largest LN size, or tumor variant.
Conclusions:
- Level I LN metastasis in N1b PTC is associated with extensive disease, indicated by multiple involved levels and extranodal invasion.
- Consideration of level I inclusion in therapeutic neck dissection for N1b PTC patients is suggested in cases with multiple LN level involvement and macroscopic extranodal invasion.
