S176 – Level II-B and V-A Lateral Neck Dissection in PTC

Objectives 1) Patterns of cervical metastasis in PTC. 2) Importance of elective dissection of levels II-B & V-A. Methods Charts were reviewed of 53 consecutive patients (February 2002-December 2007) with PTC who underwent lateral neck dissection that included at least levels II (A and B), and V (A and B). Results 53 patients underwent lateral neck dissection for FNA-confirmed nodal metastasis of PTC. 46 patients underwent unilateral neck dissection, while 7 had bilateral neck dissection, resulting in a total of 60 neck dissection specimens which were evaluated. Level II (A and B) was excised in 59/60 neck dissections, with 33 out of 59 specimens (33/59–%60) positive for metastasis. Level II-B was positive 5 times (5/59, 8.5%–95% CI: 2.4, 20.4); and each time level II-B was positive, level II-A was also positive for metastasis. Level III was excised 58 times and was positive in 38 specimens (38/58–66%). Level IV was excised 58 times and was positive in 29 specimens (29/58–50%). Level V (A and B) was excised 40 times and was positive in 16 specimens (16-40-40%). Level V-A did not account for any of the positive level V results. Conclusions Patients with PTC undergoing lateral neck dissection for FNA-confirmed nodal metastases might harbor disease in level II-B, especially if level II-A is involved. Elective dissection of level V-B should also be considered in this scenario, while routine level V-A dissection is not necessary.