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Patterns of Lateral Lymph Node Involvement by Neck Level in cNIb Differentiated Thyroid Carcinoma: A Systematic
Dana M Hartl1, Karthik N Rao2, Andrés Coca Pelaz3
1Division of Surgery and Anesthesiology, Head and Neck Oncology Service, Thyroid Surgery Unit, Gustave Roussy Cancer Campus Grand Paris, 94800 Villejuif, France.
Diagnostics (Basel, Switzerland)
|October 29, 2025
Summary
Lateral neck dissection for differentiated thyroid cancer should spare level I and specific sublevels. This systematic review found varying lymph node involvement, suggesting personalized approaches for better outcomes.
Area of Science:
- Oncology
- Surgical Oncology
- Head and Neck Surgery
Background:
- Optimal extent of lateral lymph node dissection in differentiated thyroid cancer (cN1b) is debated.
- Understanding lymph node involvement across neck levels is crucial for surgical decision-making.
Purpose of the Study:
- To systematically review and meta-analyze the frequency of lymph node metastasis across neck levels (I-V) in differentiated thyroid cancer.
- To inform guidelines on lateral neck dissection extent.
Main Methods:
- Systematic review adhering to PRISMA guidelines, searching PubMed.
- Meta-analysis of pooled prevalence proportions with random-effects model.
- Assessment of heterogeneity using I-squared statistic.
Main Results:
- Levels III (68%) and IV (66%) showed highest metastatic prevalence.
- Level IIA (46%) and VB (19%) had significant involvement, while levels I (6%) and IIB (14%) had low risk.
- Sublevel VA (4%) had minimal metastasis.
Conclusions:
- Findings support sparing level I, IIB, and VA in lateral neck dissection.
- Current guidelines may need revision regarding systematic dissection of all levels, especially VB.
- Personalized extent of neck dissection based on risk factors is recommended for optimal outcomes.
