Ann Surg Treat Res.  2018 May;94(5):229-234. 10.4174/astr.2018.94.5.229.

Extent of central lymph node dissection for papillary thyroid carcinoma in the isthmus

  • 1Department of Surgery, Korea University College of Medicine, Seoul, Korea.


The incidence of papillary thyroid carcinoma (PTC) arising from the isthmus is low; however, these tumors have aggressive clinical and pathological features. Moreover, the existing guidelines regarding the extent of surgery for this type of tumor are unclear.
This study enrolled 282 patients who underwent total thyroidectomy with bilateral central lymph node dissection. The patients were divided into 2 groups based on the location of the median line of the PTC. Group I included patients in whom the median line was located between the lateral margins of the trachea; group II included all others. We compared the 2 groups and conducted a multivariate analysis to assess risk factors for contralateral node metastasis from a PTC arising from the isthmus.
Patients in group I had significantly higher frequencies of extrathyroidal extension and central lymph node metastasis. Group I also had a higher frequency of contralateral node metastasis, and a tumor size >1.0 cm was identified as an independent risk factor for contralateral node metastasis among patients in this group.
Bilateral central lymph node dissection could be considered for patients with isthmic PTCs >1.0 cm in size who have clinically suspicious node metastasis.


Papillary thyroid carcinoma; Papillary thyroid microcarcinoma; Lymph node excision

MeSH Terms

Lymph Node Excision*
Lymph Nodes*
Multivariate Analysis
Neoplasm Metastasis
Risk Factors
Thyroid Gland*
Thyroid Neoplasms*


  • Fig. 1 Flowchart of patients with papillary thyroid cancer in this study. Group I, patients had isthmic tumors; group II, patients had lobar tumors.

  • Fig. 2 (A) Ultrasonogram of a papillary thyroid carcinoma (arrow) in the isthmus. (B) Schematic illustration of the structures used to define groups in this study. Tumors (solid circle) for which the median line (arrow) was located between the lateral margins of trachea were classified as group I; all others (dotted circle) were classified as group II. RL, right lobe; RI, right isthmus; LI, left isthmus; LL, left lobe.


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