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Tracy S. Wang, MD; Sanford Dubner, MD; Laura A. Sznyter, MD; Keith S. Heller, MD

Arch Otolaryngol Head Neck Surg. 2004;130:110-113.

Objective  To determine the incidence of clinically positive lateral cervical nodes at presentation and after initial treatment in patients with well-differentiated thyroid cancer.

Design  Retrospective chart review.

Setting  University-affiliated teaching hospitals.

Patients  A total of 508 patients who underwent a thyroidectomy as part of their initial treatment for well-differentiated thyroid carcinoma between January 1978 and December 1999. Neck dissections were performed only for clinically palpable cervical nodes.

Main Outcome Measures  Recurrence in the neck and survival.

Results  Forty-four patients (9%) had palpable lateral cervical lymph nodes at the time of surgery. All 31 patients younger than 45 years presenting with palpable positive nodes are alive and free of disease; 4 of 13 patients 45 years or older have died of thyroid cancer. Only 16 (3%) of 464 patients who did not undergo initial neck dissection had recurrence in lateral cervical nodes. Recurrence is more likely when the initial tumor is larger than 4 cm. In 216 patients younger than 45 years, there were 5 (2%) recurrences in lateral cervical nodes; these patients remain alive and free of disease. In 248 patients 45 years or older, there were 11 (4%) with recurrent disease in the lateral neck; 4 of these patients have died of thyroid cancer.

Conclusions  An aggressive approach to detecting and treating occult lateral cervical nodes by techniques such as jugular node sampling, sentinel node biopsy, or image-guided needle biopsy is not necessary in most patients. Attempts to detect and remove occult lateral cervical lymph node metastases might be considered in older patients with large primary tumors.

From the Section of Head and Neck Surgery, Department of Surgery, Long Island Jewish Medical Center, The Long Island Campus of the Albert Einstein College of Medicine, New Hyde Park, NY. The authors have no relevant financial interest in this article.

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