Patterns of lateral neck metastasis in papillary thyroid carcinoma

Background: Although lymphatic metastasis does not affect overall survival for patients with differentiated thyroid carcinoma, locoregional control can be improved with cervical lymphadenectomy. The major morbidity of neck dissection (ND) for the management of regional metastases is spinal accessory (cranial nerve XI) dysfunction. To avoid this complication, some surgeons have advocated a limited ND. Objective: To establish the patterns of lateral cervical metastases in differentiated thyroid carcinoma and the role of comprehensive ND, we performed a review of our experience with comprehensive ND. Study Design: Retrospective chart review Patients and Methods: Between 1997 and 2002, a total of 39 consecutive patients (31 women and 8 men) underwent 44 NDs for the management of lateral cervical metastases. Preoperative cytologic analysis revealed papillary carcinoma in all 39 patients (100%). All specimens were labeled and mapped by the operating surgeon to identify each level. The incidence of positive disease was determined in relation to the extent of lymphadenectomy for all dissected levels. Results: All patients underwent ND at levels 11 through V; 7 (17%) of the 44 ND specimens included level I nodes. The incidence of metastatic disease in level 11 nodes was 52% (23/44 specimens). Similarly, 25 specimens (57%) contained histologic metastases; at level III. Metastatic disease was noted in 18 level IV nodes (41%) and 9 level V nodes (21%). One (14%) of the 7 specimens with level I nodes contained tumor. Conclusions: Cervical metastases from papillary thyroid carcinoma occur in predictable patterns, with disease commonly present at levels 11 through V. We believe that a comprehensive ND, including removal of transverse cervical and spinal accessory nodes, is necessary for the complete clearance of lateral metastases.