IJOHNS  Vol.1 No.3 , November 2012
Correlation between Central and Lateral Neck Dissection in Differentiated Thyroid Carcinoma
ABSTRACT
Objective: To determine the histopathological correlation between central and lateral neck metastasis in differentiated thyroid carcinoma, and its potential therapeutic impact. Although the central neck dissection (CND) is recommended in differentiated thyroid carcinoma, the indication for lateral neck dissection (LND) remains controversial. Design: Retrospective study. Methods and Main Outcome Measures: Pathological analysis of systematic ipsilateral central neck dissection (CND) and LND performed with total thyroidectomy in differentiated thyroid carcinoma was retrospectively reviewed according to “side” and to “patient”. Results: A total of 56 sides (46 patients) were suitable for analysis. Analysis by “side” revealed that CND and LND dissection samples were both negative in 15 cases, both positive in 32, CND was positive and LND was negative for 8 cases and CND was negative and LND was positive in 1 case. The combined presence of positive LND and positive CND was therefore observed in 32/40 “sides” and 26/46 “patients”. Analysis by “side” of the impact of the treatment decision to perform ipsilateral LND only in patients with positive CND and vice versa demonstrated a sensitivity, specificity, and accuracy of 97%, 65%, and 84%, respectively. Conclusions: In most cases, the presence of positive LND was associated with positive ipsilateral CND. The very low prevalence of positive LND in patients with negative CND may justify LND as a second step procedure only in patients with positive CND, except in the case of documented lateral neck metastasis.

Cite this paper
nullO. Mazzaschi, M. Lefevre, B. Angelard, N. Chabbert-Buffet, J. Guily and S. Périé, "Correlation between Central and Lateral Neck Dissection in Differentiated Thyroid Carcinoma," International Journal of Otolaryngology and Head & Neck Surgery, Vol. 1 No. 3, 2012, pp. 109-115. doi: 10.4236/ijohns.2012.13022.
References
[1]   M. L. White and G. M. Dohert, “Level VI Lymph Node Dissection for Papillary Thyroid Cancer,” Minerva Chirurgica, Vol. 62, No. 5, 2007, pp. 383-393.

[2]   S. H. Lee, S. S. Lee, S. M. Jin, J. H. Kim and Y. S. Rho, “Predictive Factors for Central Compartment Lymph Node Metastasis in Thyroid Papillary Microcarcinoma,” Laryngoscope, Vol. 118, No. 4, 2008, pp. 659-662. doi:10.1097/MLG.0b013e318161f9d1

[3]   M. L. White, P. G. Gauger and G. M. Doherty, “Central Lymph Node Dissection in Differentiated Thyroid Cancer 2007 by the Société Internationale de Chirurgie,” World Journal of Surgery, Vol. 31, No. 5, 2007, pp. 895-904. doi:10.1007/s00268-006-0907-6

[4]   N. Palestini, A. Borasi, L. Cestino, M. Freddi, C. Odasso and A. Robecchi, “Is Central Neck Dissection a Safe Procedure in the Treatment of Papillary Thyroid Cancer? Our Experience,” Langenbeck’s Archives of Surgery, Vol. 393, No. 5, 2008, pp. 693-698. doi:10.1007/s00423-008-0360-0

[5]   Y. Ito and A. Miyauchi, “Lateral Lymph Node Dissection Guided by Preoperative and Intraoperative Findings in Differentiated Thyroid Carcinoma,” World Journal of Surgery, Vol. 32, No. 5, 2008, pp. 729-739. doi:10.1007/s00268-007-9315-9

[6]   B. J. Lee, S. G. Wang, J. C. Lee, S. M. Son, I. J. Kim and C. I. Park, “Level IIb Lymph Node Metastasis in Neck Dissection for Papillary Thyroid Carcinoma,” Archives of Otolaryngology—Head & Neck Surgery, Vol. 133, No. 10, 2007, pp. 1028-1030. doi:10.1001/archotol.133.10.1028

[7]   J. L. Roh, J. M. Kim and C. I. Park, “Lateral Cervical Lymph Node Metastases from Papillary Thyroid Carcinoma: Pattern of Nodal Metastases and Optimal Strategy for Neck Dissection,” Annals of Surgical Oncology, Vol. 15, No. 4, 2008, pp. 1177-1182. doi:10.1245/s10434-008-9813-5

[8]   A. Machens, H. J. Holzhausen and H. Dralle, “Skip Metastases in Thyroid Cancer. Leaping the Central Lymph Node Compartment,” Archives of Surgery, Vol. 139, No. 1, 2004, pp. 43-45. doi:10.1001/archsurg.139.1.43

[9]   N. Wada, Q. Y. Duh, K. Sugino, H. Iwasaki, K. Kameyna, T. Mimura, K. Ito, H. Takami and Y. Takanashi, “Lymph Node Metastasis from 259 Papillary Thyroid Microcarcinomas: Frequency, Pattern of Occurrence and Recurrence, and Optimal Strategy for Neck Dissection,” Annals of Surgery, Vol. 237, No. 3, 2003, pp. 399-407. doi:10.1097/01.SLA.0000055273.58908.19

[10]   A. Goropoulos, K. K. Karamoshos, A. Christodoulou, N. Theodoros, K. Paulou, A. Samaras, P. Xirou and I. Efstratiou, “Value of the Cervical Compartments in the Surgical Treatment of Papillary Thyroid Carcinoma,” World Journal of Surgery, Vol. 28, No. 12, 2004, pp. 1275-1281. doi:10.1007/s00268-004-7643-6

[11]   J. L. Roh, J. Y. Park and C. I. Park, “Total Thyroidectomy Plus Neck Dissection in Differentiated Papillary Thyroid Carcinoma Patients: Pattern of Nodal Metastasis, Morbidity, Recurrence, and Postoperative Levels of Serum Parathyroid Hormone,” Annals of Surgery, Vol. 245, No. 4, 2007, pp. 604-610. doi:10.1097/01.sla.0000250451.59685.67

[12]   T. Robbins, G. Clayman, P. A. Levine, J. Medina, R. Sessions, A. Shaha, P. Som and P. T. Wolf, “Neck Dissection Classification Update: Revisions Proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery,” Archives of Otolaryngology—Head & Neck Surgery, Vol. 128, No. 7, 2002, pp. 751-758.

[13]   M. E. Kupferman, M. Patterson, S. J. Mandel, V. LiVolsi and R. S. Weber, “Patterns of Lateral Neck Metastasis in Papillary Thyroid Carcinoma,” Archives of Otolaryngology—Head & Neck Surgery, Vol. 130, No. 7, 2004, pp. 857-860. doi:10.1001/archotol.130.7.857

[14]   D. S. Cooper, G. M. Doherty, B. R. Haugen, R. T. Kloos, S. L. Lee, S. J. Mandel, E. L. Mazzaferri, B. McIver, S. I. Sherman and R. M. Tuttle, “Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer. The American Thyroid Association Guidelines Taskforce,” Thyroid, Vol. 16, No. 2, 2006, pp. 109-142. doi:10.1089/thy.2006.16.109

[15]   F. Pacini, M. Schlumberger, H. Dralle, R. Elisei, J. W. A. Smit and W. Wiersinga, “European Consensus for the Management of Patients with Differentiated Thyroid Carcinoma of the Follicular Epithelium,” European Journal Endocrinology, Vol. 154, No. 6, 2006, pp. 787-803. doi:10.1530/eje.1.02158

[16]   O. Gimm, F. W. Rath and H. Drall, “Pattern of Lymph Node Metastases in Papillary Thyroid Carcinoma,” British Journal of Surgery, Vol. 85, No. 2, 1998, pp. 252-254. doi:10.1046/j.1365-2168.1998.00510.x

[17]   O. Ozaki, K. Ito, K. Kobayash, A. Suzuki and Y. Manabe, “Modified Neck Dissection for Patients with Nonadvanced, Differentiated Carcinoma of the Thyroid,” World Journal of Surgery, Vol. 12, 1988, pp. 825-829. doi:10.1007/BF01655487

[18]   Y. Ito and A. Miyauchi, “Lateral and Mediastinal Lymph Node Dissection in Differentiated Thyroid Carcinoma: Indications, Benefits, and Risks,” World Journal of Surgery, Vol. 31, No. 5, 2007, pp. 905-915. doi:10.1007/s00268-006-0722-0

[19]   M. E. Kupferman, Y. E. Weinstock, A. A. Santillan, A. Mishra, D. Roberts, G. L. Clayman and R. S. Weber, “Predictors of Level V Metastasis in Well-Differentiated Thyroid Cancer,” Head Neck, Vol. 30, No. 11, 2008, pp. 1469-1474. doi:10.1002/hed.20904

[20]   I. Schweizer, P. U. Heitz, E. Gemsenjager, A. Perren, B. Seifert and G. Schu, “Lymph Node Surgery in Papillary Thyroid Carcinoma,” Journal of the American College of Surgeons, Vol. 197, No. 2, 2003, pp. 182-190. doi:10.1016/S1072-7515(03)00421-6

[21]   A. Machens, S. Hauptmann and H. Dralle, “Lymph Node Dissection in the Lateral Neck for Completion in Central Node-Positive Papillary Thyroid Cancer,” Surgery, Vol. 145, No. 2, 2009, pp. 176-181. doi:10.1016/j.surg.2008.09.003

[22]   M. Ducci, M. Appetecchia and M. Marzetti, “Neck dissection for Surgical Treatment of Lymphnode Metastasis in Papillary Thyroid Carcinoma,” Journal of Experimental & Clinical Cancer Research, Vol. 16, No. 3, 1997, pp. 333-335.

[23]   A. P. Coatesworth and K. MacLennan, “Cervical Metastasis in Papillary Carcinoma of the Thyroid: A Histopathological Study,” International Journal of Clinical Practice, Vol. 56, No. 4, 2002, pp. 241-242.

[24]   Y. Ito, C. Tomoda, T. Uruno, Y. Takamura, A. Miya, K. Kobayashi, F. Matsuzuka, K. Kuma and A. Miyauchi, “Papillary Microcarcinoma of the Thyroid: How Should It Be Treated?” World Journal of Surgery, Vol. 28, No. 11, 2004, pp. 1115-1121. doi:10.1007/s00268-004-7644-5

[25]   M. R. Pelizzo, D. Rubello, I. M. Boschin, A. Piotto, C. Paggetta, A. Toniato, G. L. De Salvo, A. Giuliano, G. Mariani and D. Casara, “Contribution of SLN Investigation with 99 mTc-Nanocolloid in Clinical Staging of Thyroid Cancer: Technical Feasibility,” European Journal of Nuclear Medicine and Molecular Imaging, Vol. 34, No. 6, 2007, pp. 934-938. doi:10.1007/s00259-006-0316-y

[26]   R. Dzodic, I. Markovic, M. Inic, N. Jokic, I. Djurisic, M. Zegarac, G. Pupic, Milovanovic Z, V. Jovic and N. Jovanovic, “Sentinel Lymph Node Biopsy May Be Used to Support the Decision to Perform Modified Radical Neck Dissection in Differentiated Thyroid Carcinoma,” World Journal of Surgery, Vol. 30, No. 5, 2006, pp. 841-846. doi:10.1007/s00268-005-0298-0

[27]   J. L. Roh and C. I. Park, “Sentinel Lymph Node Biopsy as Guidance for Central Neck Dissection in Patients with Papillary Thyroid Carcinoma,” Cancer, Vol. 113, No. 7, 2008, pp. 1527-1531. doi:10.1002/cncr.23779

 
 
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