Int J Thyroidol.  2020 Nov;13(2):79-84. 10.11106/ijt.2020.13.2.79.

Optimal Neck Dissection Extent for Metastatic Lymph Nodes in Papillary Thyroid Cancer

• Kwon HK
• Lee BJ

• KMID: 2509185
• DOI: http://doi.org/10.11106/ijt.2020.13.2.79

Abstract

Papillary thyroid cancer (PTC) has a good prognosis, but the frequency of regional lymph node metastasis is reported to be up to 90%. In most patients with PTC, nodal metastasis occurs in a stepwise fashion, with metastasis beginning in the central cervical compartment, continuing to the ipsilateral cervical compartment. There are many controversies about the necessity of prophylactic central neck dissection (CND) and extent of therapeutic CND for lymph node metastasis. Ipsilateral CND with intraoperative frozen biopsy in PTC is a very sensitive and useful tool for the evaluation of nodal status in the central compartment. The right upper para-esophageal lymph nodes should be removed during dissection in patients with right paratracheal lymph node metastasis. Prophylactic lateral neck dissection (LND) is not recommended, and optimal extent of therapeutic LND is still controversial. Further studies on factors and clinical implications related to suprasternal lymph node metastasis are needed.

Keyword

Papillary thyroid cancer; Neck dissection; Lymph node; Metastasis

Reference

References

1. Nixon IJ, Ganly I, Patel SG, Palmer FL, Whitcher MM, Ghossein R, et al. 2012; Changing trends in well differentiated thyroid carcinoma over eight decades. Int J Surg. 10(10):618–23. DOI: 10.1016/j.ijsu.2012.10.005. PMID: 23128246.

2. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, et al. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. 2009; Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 19(11):1167–214. DOI: 10.1089/thy.2009.0110. PMID: 19860577.

3. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. 2006; Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 16(2):109–42. DOI: 10.1089/thy.2006.16.109. PMID: 16420177.

4. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2016; 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 26(1):1–133. DOI: 10.1089/thy.2015.0020. PMID: 26462967. PMCID: PMC4739132.

5. Oda H, Miyauchi A, Ito Y, Yoshioka K, Nakayama A, Sasai H, et al. 2016; Incidences of unfavorable events in the management of low-risk papillary microcarcinoma of the thyroid by active surveillance versus immediate surgery. Thyroid. 26(1):150–5. DOI: 10.1089/thy.2015.0313. PMID: 26426735. PMCID: PMC4739129.

6. Cranshaw IM, Carnaille B. 2008; Micrometastases in thyroid cancer. An important finding? Surg Oncol. 17(3):253–8. DOI: 10.1016/j.suronc.2008.04.005. PMID: 18504121.

7. Liu LS, Liang J, Li JH, Liu X, Jiang L, Long JX, et al. 2017; The incidence and risk factors for central lymph node metastasis in cN0 papillary thyroid microcarcinoma: a meta-analysis. Eur Arch Otorhinolaryngol. 274(3):1327–38. DOI: 10.1007/s00405-016-4302-0. PMID: 27645473.

8. Randolph GW, Duh QY, Heller KS, LiVolsi VA, Mandel SJ, Steward DL, et al. 2012; The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. Thyroid. 22(11):1144–52. DOI: 10.1089/thy.2012.0043. PMID: 23083442.

9. Lee YS, Shin SC, Lim YS, Lee JC, Wang SG, Son SM, et al. 2014; Tumor location-dependent skip lateral cervical lymph node metastasis in papillary thyroid cancer. Head Neck. 36(6):887–91. DOI: 10.1002/hed.23391. PMID: 23733708.

10. Machens A, Hinze R, Thomusch O, Dralle H. 2002; Pattern of nodal metastasis for primary and reoperative thyroid cancer. World J Surg. 26(1):22–8. DOI: 10.1007/s00268-001-0176-3. PMID: 11898029.

11. Yi KH, Lee EK, Kang H-C, Koh Y, Kim SW, Kim IJ, et al. 2016; 2016 revised Korean Thyroid Association management guidelines for patients with thyroid nodules and thyroid cancer. Int J Thyroid. 9(2):59–126. DOI: 10.11106/ijt.2016.9.2.59.

12. Carty SE, Cooper DS, et al. American Thyroid Association Surgery Working Group. American Association of Endocrine Surgeons. American Academy of Otolaryngogology-Head and Neck Surgery. American Head and Neck Society; . 2009; Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid. 19(11):1153–8. DOI: 10.1089/thy.2009.0159. PMID: 19860578.

13. Robbins KT, Shaha AR, Medina JE, Califano JA, Wolf GT, Ferlito A, et al. 2008; Consensus statement on the classification and terminology of neck dissection. Arch Otolaryngol Head Neck Surg. 134(5):536–8. DOI: 10.1001/archotol.134.5.536. PMID: 18490577.

14. Shin SC, Lee BJ. 2018; Is prophylactic central node dissection omissible? Korean J Head Neck Oncol. 34(1):1–7. DOI: 10.21593/kjhno/2018.34.1.1.

15. Kim E, Park JS, Son KR, Kim JH, Jeon SJ, Na DG. 2008; Preoperative diagnosis of cervical metastatic lymph nodes in papillary thyroid carcinoma: comparison of ultrasound, computed tomography, and combined ultrasound with computed tomography. Thyroid. 18(4):411–8. DOI: 10.1089/thy.2007.0269. PMID: 18358074.

16. Wada N, Duh QY, Sugino K, Iwasaki H, Kameyama K, Mimura T, et al. 2003; Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg. 237(3):399–407. DOI: 10.1097/01.SLA.0000055273.58908.19. PMID: 12616125. PMCID: PMC1514312.

17. Costa S, Giugliano G, Santoro L, Ywata De Carvalho A, Massaro MA, Gibelli B, et al. 2009; Role of prophylactic central neck dissection in cN0 papillary thyroid cancer. Acta Otorhinolaryngol Ital. 29(2):61–9. PMID: 20111614. PMCID: PMC2808683.

18. Zhao W, You L, Hou X, Chen S, Ren X, Chen G, et al. 2017; The effect of prophylactic central neck dissection on locoregional recurrence in papillary thyroid cancer after total thyroidectomy: a systematic review and meta-analysis : pCND for the locoregional recurrence of papillary thyroid cancer. Ann Surg Oncol. 24(8):2189–98. DOI: 10.1245/s10434-016-5691-4. PMID: 27913945.

19. Ahn SH, Kim WS. 2020; The effect of prophylactic central neck dissection during hemithyroidectomy on locoregional recurrence in patients with papillary thyroid carcinoma: a meta-analysis. Clin Exp Otorhinolaryngol. 13(2):194–202. DOI: 10.21053/ceo.2019.01634. PMID: 32434311. PMCID: PMC7248614.

20. Chisholm EJ, Kulinskaya E, Tolley NS. 2009; Systematic review and meta-analysis of the adverse effects of thyroidectomy combined with central neck dissection as compared with thyroidectomy alone. Laryngoscope. 119(6):1135–9. DOI: 10.1002/lary.20236. PMID: 19358241.

21. Lang BH, Ng SH, Lau LL, Cowling BJ, Wong KP, Wan KY. 2013; A systematic review and meta-analysis of prophylactic central neck dissection on short-term locoregional recurrence in papillary thyroid carcinoma after total thyroidectomy. Thyroid. 23(9):1087–98. DOI: 10.1089/thy.2012.0608. PMID: 23402640.

22. Lee YS, Lee BJ, Hong HJ, Lee KD. 2017; Current trends of practical issues concerning micropapillary thyroid carcinoma: the Korean Society of Thyroid-Head and Neck Surgery. Medicine (Baltimore). 96(45):e8596. DOI: 10.1097/MD.0000000000008596. PMID: 29137085. PMCID: PMC5690778.

23. Giordano D, Valcavi R, Thompson GB, Pedroni C, Renna L, Gradoni P, et al. 2012; Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid. 22(9):911–7. DOI: 10.1089/thy.2012.0011. PMID: 22827494.

24. Lee J, Lee SG, Kim K, Yim SH, Ryu H, Lee CR, et al. 2019; Clinical value of lymph node ratio integration with the 8(th) edition of the UICC TNM classification and 2015 ATA risk stratification systems for recurrence prediction in papillary thyroid cancer. Sci Rep. 9(1):13361. DOI: 10.1038/s41598-019-50069-4. PMID: 31527831. PMCID: PMC6746784.

25. Choi SY, Cho JK, Moon JH, Son YI. 2016; Metastatic lymph node ratio of central neck compartment has predictive values for locoregional recurrence in papillary thyroid microcarcinoma. Clin Exp Otorhinolaryngol. 9(1):75–9. DOI: 10.21053/ceo.2016.9.1.75. PMID: 26976031. PMCID: PMC4792245.

26. Agrawal N, Evasovich MR, Kandil E, Noureldine SI, Felger EA, Tufano RP, et al. 2017; Indications and extent of central neck dissection for papillary thyroid cancer: an American Head and Neck Society consensus statement. Head Neck. 39(7):1269–79. DOI: 10.1002/hed.24715. PMID: 28449244.

27. Yan B, Hou Y, Chen D, He J, Jiang Y. 2018; Risk factors for contralateral central lymph node metastasis in unilateral cN0 papillary thyroid carcinoma: a meta-analysis. Int J Surg. 59:90–8. DOI: 10.1016/j.ijsu.2018.09.004. PMID: 30342280.

28. Lim YS, Choi SW, Lee YS, Lee JC, Lee BJ, Wang SG, et al. 2013; Frozen biopsy of central compartment in papillary thyroid cancer: quantitative nodal analysis. Head Neck. 35(9):1319–22. DOI: 10.1002/hed.23129. PMID: 22907829.

29. Lee WY, Lee BJ. 2013; Controvery of the surgery of paillary thyroid cancer : conventional open thyroidectomy. J Clinical Otolaryngol. 24(2):156–62. DOI: 10.35420/jcohns.2013.24.2.156.

30. Lee BJ, Lee JC, Wang SG, Kim YK, Kim IJ, Son SM. 2009; Metastasis of right upper para-esophageal lymph nodes in central compartment lymph node dissection of papillary thyroid cancer. World J Surg. 33(10):2094–8. DOI: 10.1007/s00268-009-0149-5. PMID: 19641954.

31. Park YM, Lee SM, Kim DW, Shin SC, Lee BJ. 2017; Predictive factors of right paraesophageal lymph node metastasis in papillary thyroid carcinoma: single center experience and meta-analysis. PLoS One. 12(5):e0177956. DOI: 10.1371/journal.pone.0177956. PMID: 28545107. PMCID: PMC5435339.

32. Kim D, Kwon HK, Shin SC, Sung ES, Jeon YK, Kim BH, et al. 2019; Right posterior paratracheal lymph nodes metastasis is one of the predictive factors in right-sided papillary thyroid carcinoma. Surgery. 166(6):1154–9. DOI: 10.1016/j.surg.2019.06.024. PMID: 31444006.

33. Lim YS, Lee JC, Lee YS, Lee BJ, Wang SG, Son SM, et al. 2011; Lateral cervical lymph node metastases from papillary thyroid carcinoma: predictive factors of nodal metastasis. Surgery. 150(1):116–21. DOI: 10.1016/j.surg.2011.02.003. PMID: 21507446.

34. Mulla MG, Knoefel WT, Gilbert J, McGregor A, Schulte KM. 2012; Lateral cervical lymph node metastases in papillary thyroid cancer: a systematic review of imaging-guided and prophylactic removal of the lateral compartment. Clin Endocrinol (Oxf). 77(1):126–31. DOI: 10.1111/j.1365-2265.2012.04336.x. PMID: 22233478.

35. Stack BC Jr, Ferris RL, Goldenberg D, Haymart M, Shaha A, Sheth S, et al. 2012; American Thyroid Association consensus review and statement regarding the anatomy, terminology, and rationale for lateral neck dissection in differentiated thyroid cancer. Thyroid. 22(5):501–8. DOI: 10.1089/thy.2011.0312. PMID: 22435914.

36. Caron NR, Tan YY, Ogilvie JB, Triponez F, Reiff ES, Kebebew E, et al. 2006; Selective modified radical neck dissection for papillary thyroid cancer-is level I, II and V dissection always necessary? World J Surg. 30(5):833–40. DOI: 10.1007/s00268-005-0358-5. PMID: 16555024.

37. Won HR, Chang JW, Kang YE, Kang JY, Koo BS. 2018; Optimal extent of lateral neck dissection for well-differentiated thyroid carcinoma with metastatic lateral neck lymph nodes: a systematic review and meta-analysis. Oral Oncol. 87:117–25. DOI: 10.1016/j.oraloncology.2018.10.035. PMID: 30527226.

38. Lee BJ, Wang SG, Lee JC, Son SM, Kim IJ, Kim YK. 2007; Level IIb lymph node metastasis in neck dissection for papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg. 133(10):1028–30. DOI: 10.1001/archotol.133.10.1028. PMID: 17938327.

39. Kim SK, Park I, Hur N, Lee JH, Choe JH, Kim JH, et al. 2017; Should level V be routinely dissected in N1b papillary thyroid carcinoma? Thyroid. 27(2):253–60. DOI: 10.1089/thy.2016.0364. PMID: 27762727.

40. Sun G, Wang Y, Zhu Y, Wang Y, Xu K, Wei W, et al. 2013; Lymph node metastasis between sternocleidomastoid and sternohyoid muscle in clinically node-positive papillary thyroid carcinoma. Head Neck. 35(8):1168–70. DOI: 10.1002/hed.23099. PMID: 22927223.

41. Yu ST, Ge JN, Sun BH, Wei ZG, Lei ST. 2019; Lymph node metastasis in suprasternal space in pathological node-positive papillary thyroid carcinoma. Eur J Surg Oncol. 45(11):2086–9. DOI: 10.1016/j.ejso.2019.07.034. PMID: 31395292.