Ann Surg Treat Res.  2022 Feb;102(2):83-89. 10.4174/astr.2022.102.2.83.

The effect of intraoperative neuromonitoring on the number of lymph nodes excised and recurrence when applied during neck dissection in cases of papillary thyroid cancer

• Çomçalı B
• Saylam B
• Özdemir BA

• KMID: 2525445
• DOI: http://doi.org/10.4174/astr.2022.102.2.83

Abstract

Purpose
The aim of this study was to evaluate the effect of neuromonitoring on the number of lymph nodes (LNs) removed when applied during neck dissection.
Methods
A total of 166 patients receiving neck dissection due to papillary thyroid cancer were separated into 2 groups (monitoring group, n = 76; non-monitoring group, n = 90).
Results
The number of LNs dissected was observed to be statistically significantly higher in the monitoring group (P = 0.001), and the difference between the groups in the number of positive LNs was significant (P = 0.031). There was seen to be a negative relationship between the number of positive LNs dissected and recurrence (r = –0.404, P = 0.005).
Conclusion
Intraoperative neuromonitoring during neck dissection makes a positive contribution to the prevention of the development of recurrence by increasing the number of LNs excised and the number of metastatic LNs.

Keyword

Intraoperative neuromonitoring; Lymph node excision; Papillary thyroid cancer; Recurrence

Figure

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  Fig. 1 The number of lymph nodes (LNs) dissected was observed to be significantly higher in the monitoring group.

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  Fig. 2 In the monitoring group, the number of lymph nodes (LNs) excised was significantly higher in both CLND materials (P = 0.027) and MLND materials (P = 0.005). IONM, intraoperative neuromonitoring; CLND, central LN dissection; MLND, modified radical LN dissection.

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  Fig. 3 In the receiver operating characteristic (ROC) analysis, metastatic lymph node ratio was seen to constitute a serious risk for the development of disease recurrence. Area under the curve ROC, 0.886 ± 0.030 (95% CI, 0.826–0.946); P < 0.001; sensitivity of 68.8% and specificity of 85.2%. Diagnal segments are produced by ties.

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