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Predicting occult lymph node metastasis in level II using preoperative factors.

Chengwei Xing1, Siyuan Xu2, Ruiying Liu1

  • 1Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

Oral Oncology
|January 7, 2026
PubMed
Summary

Occult lymph node metastasis in level II of papillary thyroid carcinoma is linked to primary tumor size and metastatic burden. Super-selective neck dissection may benefit patients with smaller tumors and less advanced nodal disease.

Keywords:
Neck dissectionOccult lymph node metastasisPapillary thyroid cancer

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Head and Neck Surgery

Background:

  • Super-selective neck dissection, sparing levels II and V, is debated for papillary thyroid carcinoma (PTC) to preserve neck function.
  • Occult lymph node metastasis (OLNM) in level II is a key concern in PTC treatment.
  • This study investigates the relationship between OLNM in level II and preoperative clinical factors in PTC patients.

Purpose of the Study:

  • To explore the association between occult lymph node metastasis (OLNM) in level II and preoperative clinical characteristics in papillary thyroid carcinoma (PTC).
  • To evaluate the prognostic value of level II OLNM in PTC patients.

Main Methods:

  • Retrospective analysis of 640 unilateral cN1b PTC patients undergoing surgery (2000-2017).
  • Logistic regression used to assess OLNM in level II based on preoperative characteristics.
  • Restricted cubic spline examined the association between level II OLNM and nodal distribution in levels III and IV.
  • Kaplan-Meier method and Cox regression evaluated the prognosis of level II OLNM.

Main Results:

  • 48.0% of patients had OLNM in level II.
  • Primary tumor size (>1.5 cm) and multiple positive clinical lymph nodes significantly increased the risk of level II OLNM.
  • A non-linear relationship was observed between level II OLNM and metastatic lymph nodes in levels III and IV.
  • No significant difference in recurrence-free survival (all-site or regional) was found between patients with or without level II OLNM.

Conclusions:

  • Primary tumor size and metastatic burden in adjacent cervical compartments are associated with the risk of level II OLNM in PTC.
  • Super-selective neck dissection, potentially omitting level II, could be considered for PTC patients with small primary tumors and low metastatic burden.