Surgical drains can be safely avoided in lateral neck dissections for papillary thyroid cancer

Abstract Context: The risk of loco-regional recurrence in papillary thyroid cancer (PTC) patients ranges from 15–30%. However, the clinical significance of small-volume loco-regional recurrence detected by highly sensitive ultrasonography is unclear. Objective: Our objective was to describe the natural history of abnormal cervical lymph nodes (LN) diagnosed after initial treatment. Design: We conducted a retrospective cohort study. Patients: 166 PTC with patients who had at least one abnormal LN outside the thyroid be on ultrasound and selected for active surveillance were included. Main Outcome Measure: LN growth during a period of active surveillance was the primary outcome. Results: Most patients had classical PTC (85%) and an intermediate risk of recurrence (77%). The median LN size at the start of the observation period was 1.3 cm (range, 0.5–2.7 cm) in largest diameter, with all nodes having at least one abnormal sonographic characteristic (70% of patients had LN with at least two abnormal features). In almost all patients, the LN were in the lateral neck, primarily in levels 3 (43%) and 4 (58%). After a median follow-up of 3.5 yr, only 20% (33 of 166) grew at least 3 mm, 9% (15 of 166) grew at least 5 mm, and 14% (23 of 166) resolved. None of the clinical or sonographic features were predictive of LN growth (positive predictive value range = 0.21–0.57). There were no local complications (nerve damage or local invasion) related to the abnormal nodes and no disease-related mortality. Conclusions: Suspicious cervical LN in the lateral neck usually remain stable for long periods of time in properly selected PTC patients and can be safely followed with serial ultrasounds

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Number of lymph nodes removed during modified radical neck dissection for papillary thyroid cancer does not influence lateral neck recurrence

Surgery ◽

10.1016/j.surg.2012.08.025 ◽

2012 ◽

Vol 152 (6) ◽

pp. 1177-1183 ◽

Cited By ~ 12

Author(s):

Maria B. Albuja-Cruz ◽

Chad M. Thorson ◽

Bassan J. Allan ◽

John I. Lew ◽

Steven E. Rodgers

Keyword(s):

Thyroid Cancer ◽

Lymph Nodes ◽

Neck Dissection ◽

Papillary Thyroid Cancer ◽

Radical Neck Dissection ◽

Lateral Neck ◽

Papillary Thyroid ◽

Modified Radical Neck Dissection ◽

Neck Recurrence

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Utility of Surgeon-Performed Ultrasound Assessment of the Lateral Neck for Metastatic Papillary Thyroid Cancer

Journal of Oncology ◽

10.1155/2012/973124 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Cortney Y. Lee ◽

Samuel K. Snyder ◽

Terry C. Lairmore ◽

Sean C. Dupont ◽

Daniel C. Jupiter

Keyword(s):

Thyroid Cancer ◽

Lymph Nodes ◽

Papillary Thyroid Cancer ◽

Metastatic Disease ◽

Needle Aspiration ◽

Lateral Neck ◽

Papillary Thyroid ◽

Imaging Studies ◽

Cervical Lymph Nodes ◽

Ultrasound Assessment

Ultrasound is the recommended staging modality for papillary thyroid cancer. Surgeons proficient in US assessment of the neck and experienced in the management of papillary thyroid cancer (PTC) appear uniquely qualified to assess the lateral cervical lymph nodes for metastatic disease. Of 310 patients treated for PTC between 2000 and 2008, 109 underwent surgeon-performed ultrasound (SUS) of the lateral neck preoperatively. Fine needle aspiration was performed on suspicious lateral lymph nodes. SUS findings were compared with FNA cytology and results of postoperative imaging studies. The sensitivity and negative predictive value of SUS were 88% and 97%, respectively. Four patients were found to have missed metastatic disease within 6 months. No patient underwent a nontherapeutic neck dissection. SUS combined with US-guided FNA of suspicious lymph nodes can accurately stage PTC to reliably direct surgical management.

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Individualized optimal surgical extent of the lateral neck in papillary thyroid cancer with lateral cervical metastasis

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-013-2630-x ◽

2013 ◽

Vol 271 (6) ◽

pp. 1355-1360 ◽

Cited By ~ 8

Author(s):

Jae-Yong Park ◽

Bon Seok Koo

Keyword(s):

Thyroid Cancer ◽

Papillary Thyroid Cancer ◽

Lateral Neck ◽

Papillary Thyroid ◽

Cervical Metastasis ◽

Surgical Extent

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Patterns of Cervical Lymph Node Metastases in Primary and Recurrent Papillary Thyroid Cancer

Journal of Oncology ◽

10.1155/2011/735678 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 12

Author(s):

Neda Ahmadi ◽

Ameet Grewal ◽

Bruce J. Davidson

Keyword(s):

Thyroid Cancer ◽

Papillary Thyroid Cancer ◽

Recurrent Disease ◽

The United States ◽

Common Type ◽

Lateral Neck ◽

Papillary Thyroid ◽

Level Ii ◽

Node Metastases ◽

Level I

The incidence of thyroid cancer is rising in the United States with papillary thyroid cancer (PTC) being the most common type. We performed a retrospective study of 49 patients with PTC who underwent 57 lateral neck dissections (NDs). The extent of NDs varied, but 29 of 57 (51%) consisted of levels II–V. Twelve of 57 (21%) NDs consisted of levels I–V. Twelve of 57 (21%) NDs consisted of levels II–IV. One of 57 (1.8%) necks involved only levels I–IV. One of 57(1.8%) necks involved only levels I–V. One of 57(1.8%) necks involved only levels III–V. Two (3.5%) double-level (III–IV) neck surgeries were also performed. Metastatic PTC adenopathy was confirmed pathologically in 2%-level-I, 45%-level-II, 57%-level-III, 60%-level-IV, and 22%-level-V necks. Level-V was positive in 21% of primary and 24% of recurrent groups (). Comparing primary and recurrent disease, there was no difference in nodal distribution or frequency for levels I, II, III, and V. Level-IV was more common in the recurrent cases (). Based on the pathologic distribution of nodes, dissection should routinely include levels II–IV and extend to level-V in primary and recurrent cases. Our data does not suggest routine dissection of level-I.

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