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

  • 1Department of General Surgery, Ankara City Hospital, Ankara, Turkey


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.
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).
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).
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.


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


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

  • 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.

  • 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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