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Efficacy of Superselective Neck Dissection in Detecting Metastasis in Patients with cN0 Papillary Thyroid Carcinoma at High Risk of Lateral Neck Metastasis

Changming An, Xiwei Zhang, Shixu Wang, Zongmin Zhang, Yulin Yin, Zhengang Xu, Pingzhang Tang, Zhengjiang Li

(Department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Science (CAMS), Peking Union Medical College (PUMC), Beijing, China (mainland))

Med Sci Monit 2017; 23:2118-2126

DOI: 10.12659/MSM.900273

Published: 2017-05-04

BACKGROUND: This study aimed to evaluate superselective neck dissection (SSND) in patients with cN0 papillary thyroid carcinoma (PTC) at high risk of lateral cervical lymph node (LN) metastasis.
MATERIAL AND METHODS: This study enrolled 138 patients with PTC who underwent SSND. These patients were at high risk for LN metastasis and the rate of cervical LN metastasis was recorded.
RESULTS: In all, 146 lateral neck dissections were performed in 138 patients. Intraoperative pathological data revealed LN metastasis from 55 cases, for which Level II and V dissection were performed. Ninety SSNDs were performed in the other 83 patients without metastasis identified in frozen sections. Occult lymph node metastasis (OLNM) rates were 56.8% and 43.5% in the central compartment and lateral neck, respectively. OLNM rates of Level II–VI were 17.8%, 31.5%, 36.3%, 1.4%, and 56.8%, respectively. Level VI metastasis (p<0.001), extra thyroidal extension (p=0.003), and tumor size (p=0.011) were significant factors for lateral neck LN metastasis.
CONCLUSIONS: SSND might be effective for early diagnosis of lateral neck metastases of PTC. Patients with OLNM should receive level II, III, and IV dissection, but level V dissection could be omitted.

Keywords: Lymph Nodes, Neck Dissection, Parathyroid Neoplasms