Abstract
Aims
Systematic lymph node dissection in patients with papillary thyroid carcinoma (PTC)
remains controversial. The objective of this study was to study the pattern of lymph
node spread in patients with PTC clinically node-negative and then to propose a lymph
node management strategy.
Methods
We retrospectively reviewed the records of patients who had undergone total thyroidectomy
and a systematic central neck dissection (CND) and lateral neck dissection. Ninety
patients with PTC without lymph nodes metastases (LNM) detected on preoperative palpation
and ultrasonographic examination were included.
Results
Forty-one patients (45.5%) had LNM. Twenty-eight patients (31%) had a central and
a lateral involvement. Thirteen patients (14.5%) had only a central involvement. All
the patients without LNM in the central compartment were also free in the lateral
compartment. There was no correlation between LNM status and TNM staging.
The largest LNM in the central compartment was smaller than or equal to 5 mm in 66% of the cases, and that could explain the lack of sensitivity of the preoperative
ultrasonographic examination.
Conclusion
CND could be considered at preoperative or intraoperative diagnosis of PTC whereas
lateral neck dissection should be performed only in patients with preoperative suspected
and/or intraoperatively proven LNM. Systematic CND allows an objective evaluation
of lymph node status in this central cervical area where the LNM are particularly
small and difficult to detect preoperatively.
Keywords
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Article info
Publication history
Accepted:
June 7,
2010
Footnotes
☆A part of the results was presented as an oral communication at the 32nd annual meeting of the European Thyroid Association, Leipzig, September 4th, 2007.
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
