Pattern of Lateral Neck Metastasis and Predictors of Level V Metastasis in Papillary Thyroid Carcinoma

Taeryung Kim M.D.; Youngdon Lee M.D.; Heungkyu Park M.D.; Yooseung Chung M.D.; Soryung Ku M.D.

doi:10.16956/kjes.2011.11.3.164

Journal List > Korean J Endocr Surg > v.11(3) > 1060031

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M.D., M.D., M.D., M.D., and M.D.: Pattern of Lateral Neck Metastasis and Predictors of Level V Metastasis in Papillary Thyroid Carcinoma

Review Article

Korean J Endocrine Surg 2011;11(3):164-168.

Published online: 18 September 2011

DOI: https://doi.org/10.16956/kjes.2011.11.3.164

Pattern of Lateral Neck Metastasis and Predictors of Level V Metastasis in Papillary Thyroid Carcinoma

Taeryung Kim M.D., Youngdon Lee M.D., Ph.D., Heungkyu Park M.D., Ph.D., Yooseung Chung M.D., Ph.D., Soryung Ku M.D.

Department of Endocrine Surgery, Gachon University Gil Hospital, Incheon, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

Cervical lymphadenectomy is frequently performed in patients with lateral cervical lymph node metastasis to improve regional control of disease. However, there is controversy regarding appropriate levels of the neck that need to be dissected. In particular, the routine dissection of level V remains an annoying and time consuming procedure due to the injury of the spinal accessory nerve.

Methods:

To identify clinical and pathological predictors of cervical node metastases to level V in papillary thyroid carcinoma, we analyzed 42 patients who underwent modified radical neck dissection (MRND), which were separately performed by each strict anatomical level. Five patients underwent both MRND, 29 patients received total thyroidectomy with central neck node dissection and MRND at the time of initial operation. Thirteen patients underwent MRND later when lateral neck metastases were found at the follow-up after total thyroidectomy with central neck node dissection.

Results:

In our series, 11.9% of neck specimens harbored metastatic thyroid carcinoma at level V. The metastatic rate of level II, III, and IV was 54.7%, 85.7%, and 64.2%, respectively. The presence of level V metastases was not significantly associated with level II, III metastases, age, sex, and histopathologic findings. But, it seemed to be associated with level IV metastases if the proportion of metastasis of level IV exceeded 50%.

Conclusion:

Cervical node metastasis seems to be associated with level IV metastases if the proportion of meta-stasis of level IV exceeds 50%.

Keywords: Papillary thyroid carcinoma, Lateral neck node metastasis, Modified radical neck node dissection, Level V metastases

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Fig. 1

The six Levels and six sublevels of the neck according to the 2002 neck dissection classification update.(22)

Table 1.

Mean number of Retrieved and metastatic lymph node and percentage(%) of patient with metastatic lymph node in lateral neck

Neck level	Number of retrieved LN (mean±SD)	Number of metastatic LN (mean±SD)	% of patient with metastatic lymph node
II	12.7±5.3	1.4±1.9	54.7 (23/42)
IIA	9.1±3.5	0.9±1.4	47.0 (8/17)
IIB	4.4±2.2	0.1±0.5	5.8 (1/17)
III	11.7±7.4	3.7±3.0	85.7 (36/42)
IV	10.3±6.5	2.4±2.4	64.2 (27/42)
V	7.5±5.9	0.3±0.9	11.9 (5/42)
Total	10.5±6.6	2.0±2.5	97.6 (41/42)
II-VI	59.3±17.5	22.9±11.6	100 (42/42)

Table 2.

Univariate analysis of variables for metastasis of level V

Variables		Patients with positive node/ total patients	P value
Age (years)	＜45	3/22	.547
	≥45	2/20
Sex	Male	0/3	.677
	Female	5/39
Level II metastasis	Yes	4/23	.237
	No	1/19
Level III metastasis	Yes	4/36	.557
	No	1/6
Level IV metastasis	Yes	5/27	.095
	No	0/15
Tumor size	＜1 cm	0/5	.512
	≥1 cm	5/37
Multifocality	Yes	1/26	.061
	No	4/16
II＋III＋IV	Yes	4/15	.047∗
	No	1/27
No. of metastatic lymph	1	0/1	.878
nodes in level II-IV	≥2	5/40
Lymphovascular invasion	Yes	2/8	.237
	No	3/34
Capsular invasion	Yes	4/36	.557
	No	1/6
≥50% metastasis	Yes	2/4	.063
in level II	No	3/38
≥50% metastasis	Yes	2/11	.408
in level III	No	3/30
≥50% metastasis	Yes	4/12	.022∗
in level IV	No	1/28

^∗ P＜.05 between the two categories for a given variable.

Table 3.

Multivariate logistic regression for level V lymph node metastasis

Variable	B (SE)	P value	Exp (B)	95% CI Exp (B)
Variable	B (SE)	P value	Exp (B)	Lower	Upper
Metastasis of II＋III＋IV	3.206 (1.502)	.033	24.693	1.300	469.050
≥50% metastasis in level IV	3.560 (1.492)	.017	35.180	1.890	654.822
Constant	−5.581 (1.744)

B = beta; SE = standard error; Exp (B); 95% CI = 95% confidence interval.

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