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Michael E. Kupferman, MD; Michael Patterson, BS; Susan J. Mandel, MD, MPH; Virginia LiVolsi, MD; Randal S. Weber, MD

Arch Otolaryngol Head Neck Surg. 2004;130:857-860.

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 II through V; 7 (17%) of the 44 ND specimens included level I nodes. The incidence of metastatic disease in level II 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 II 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.

From the Department of Otolaryngology–Head and Neck Surgery (Drs Kupferman and Weber and Mr Patterson), the Department of Medicine, Division of Endocrinology (Dr Mandel), and the Department of Pathology and Laboratory Medicine (Dr LiVolsi), University of Pennsylvania School of Medicine, Philadelphia. Dr Weber is now with the Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston. The authors have no relevant financial interest in this article.

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