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Relevance of level IIb neck dissection in patients with papillary thyroid carcinoma

Published online by Cambridge University Press:  23 February 2021

S Hosokawa*
Affiliation:
Department of Otorhinolaryngology/Head and Neck Surgery, Hamamatsu University School of Medicine, Japan
G Takahashi
Affiliation:
Department of Otorhinolaryngology/Head and Neck Surgery, Hamamatsu University School of Medicine, Japan Yamahoshi ENT Clinic, Hamamatsu, Japan
J Okamura
Affiliation:
Department of Otorhinolaryngology/Head and Neck Surgery, Hamamatsu University School of Medicine, Japan Department of Otorhinolaryngology, Seirei Hamamatsu General Hospital, Japan
A Imai
Affiliation:
Department of Otorhinolaryngology/Head and Neck Surgery, Hamamatsu University School of Medicine, Japan
D Mochizuki
Affiliation:
Department of Otorhinolaryngology/Head and Neck Surgery, Hamamatsu University School of Medicine, Japan
R Ishikawa
Affiliation:
Department of Otorhinolaryngology/Head and Neck Surgery, Hamamatsu University School of Medicine, Japan
Y Takizawa
Affiliation:
Department of Otorhinolaryngology/Head and Neck Surgery, Hamamatsu University School of Medicine, Japan
K Misawa
Affiliation:
Department of Otorhinolaryngology/Head and Neck Surgery, Hamamatsu University School of Medicine, Japan
K Shinmura
Affiliation:
Department of Tumor Pathology, Hamamatsu University School of Medicine, Japan
H Mineta
Affiliation:
Department of Otorhinolaryngology/Head and Neck Surgery, Hamamatsu University School of Medicine, Japan
*
Author for correspondence: Dr Seiji Hosokawa, Department of Otorhinolaryngology/Head and Neck Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka431-3192, Japan E-mail: [email protected] Fax: +81 53 435 2253

Abstract

Background

Cervical nodal metastasis is a key prognostic factor in patients with papillary thyroid carcinoma. The role of lymph nodes in papillary thyroid carcinoma management and prognosis remains controversial.

Methods

Level IIb lymph nodes obtained from 44 patients with papillary thyroid carcinoma were histopathologically examined retrospectively. Specimens were classified as ipsilateral or contralateral. The number of dissected nodes and prevalence of level IIb metastasis were compared according to pre-operative clinical nodal stage.

Results

In the node-negative neck, the prevalence of contralateral and ipsilateral IIb nodes was 0 out of 20 and 0 out of 3, respectively. In the node-positive neck, the prevalence of contralateral and ipsilateral IIb nodes was 1 out of 13 (7.70 per cent) and 3 out of 41 (7.32 per cent), respectively. Clinically determined and pathologically confirmed level IIb node negativity were significantly associated. Thirty-four patients (77.3 per cent) developed accessory nerve complications from level IIb dissection.

Conclusion

Level IIb neck dissection for papillary thyroid carcinoma may be required if pre-operative examination reveals multilevel, level IIa or suspicious level IIb metastasis.

Type
Main Articles
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Dr S Hosokawa takes responsibility for the integrity of the content of the paper

References

Davidson, HC, Park, BJ, Johnson, JT. Papillary thyroid cancer: controversies in the management of neck metastasis. Laryngoscope 2008;118:2161–5CrossRefGoogle ScholarPubMed
Robbins, KT, Clayman, G, Levine, PA, Medina, J, Sessions, R, Shaha, A et al. ; American Head and Neck Society; American Academy of Otolaryngology--Head and Neck Surgery. Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery. Arch Otolaryngol Head Neck Surg 2002;128:751–8CrossRefGoogle ScholarPubMed
Koybasioğlu, A, Uslu, S, Yilmaz, M, Inal, E, Ileri, F, Asal, K. Lymphatic metastasis to the supraretrospinal recess in laryngeal squamous cell carcinoma. Ann Otol Rhinol Laryngol 2002;111:96–9CrossRefGoogle ScholarPubMed
Stack, BC Jr, Ferris, RL, Goldenberg, D, Haymart, M, Shaha, A, Sheth, S et al. American Thyroid Association consensus review and statement regarding the anatomy, terminology, and rationale for lateral neck dissection in differentiated thyroid cancer. Thyroid 2012;22:501–8CrossRefGoogle ScholarPubMed
Silverman, DA, El-Hajj, M, Strome, S, Esclamado, RM. Prevalence of nodal metastases in the submuscular recess (level IIb) during selective neck dissection. Arch Otolaryngol Head Neck Surg 2003;129:724–8CrossRefGoogle ScholarPubMed
Sezen, OS, Kubilay, U, Haytoglu, S, Unver, S. Frequency of metastases at the area of the supraretrospinal (level IIB) lymph node in laryngeal cancer. Head Neck 2007;29:1111–14CrossRefGoogle ScholarPubMed
Kou, Y, Zhao, T, Huang, S, Liu, J, Duan, W, Wang, Y et al. Cervical level IIb metastases in squamous cell carcinoma of the oral cavity: a systematic review and meta-analysis. Onco Targets Ther 2017;10:4475–83CrossRefGoogle ScholarPubMed
Perie, S, Lesnik, M, Samaha, S, Lacau St Guily, J. How to release neck dissections: role of the triangle between the spinal accessory nerve and the internal jugular vein. Eur Ann Otorhinolaryngol Head Neck Dis 2017;134:201–3CrossRefGoogle ScholarPubMed
Vayisoglu, Y, Ozcan, C, Turkmenoglu, O, Gorur, K, Unal, M, Dag, A et al. Level IIb lymph node metastasis in thyroid papillary carcinoma. Eur Arch Otorhinolaryngol 2010;267:1117–21CrossRefGoogle ScholarPubMed
Lombardi, D, Paderno, A, Giordano, D, Barbieri, D, Taboni, S, Piazza, C et al. Therapeutic lateral neck dissection in well-differentiated thyroid cancer: analysis on factors predicting distribution of positive nodes and prognosis. Head Neck 2018;40:242–50CrossRefGoogle ScholarPubMed
Won, HR, Chang, JW, Kang, YE, Kang, JY, Koo, BS. Optimal extent of lateral neck dissection for well-differentiated thyroid carcinoma with metastatic lateral neck lymph nodes: a systematic review and meta-analysis. Oral Oncol 2018;87:117–25CrossRefGoogle ScholarPubMed
Yanir, Y, Doweck, I. Regional metastases in well-differentiated thyroid carcinoma: pattern of spread. Laryngoscope 2008;118:433–6CrossRefGoogle Scholar
Goropoulos, A, Karamoshos, K, Christodoulou, A, Ntitsias, T, Paulou, K, Samaras, A et al. Value of the cervical compartments in the surgical treatment of papillary thyroid carcinoma. World J Surg 2004;28:1275–81CrossRefGoogle ScholarPubMed
Koo, BS, Choi, EC, Yoon, YH, Kim, DH, Kim, EH, Lim, YC. Predictive factors for ipsilateral or contralateral central lymph node metastasis in unilateral papillary thyroid carcinoma. Ann Surg 2009;249:840–4CrossRefGoogle ScholarPubMed
Noguchi, S, Murakami, N, Yamashita, H, Toda, M, Kawamoto, H. Papillary thyroid carcinoma: modified radical neck dissection improves prognosis. Arch Surg 1998;133:276–80CrossRefGoogle ScholarPubMed
Gimm, O, Rath, FW, Dralle, H. Pattern of lymph node metastases in papillary thyroid carcinoma. Br J Surg 1998;85:252–4CrossRefGoogle ScholarPubMed
Sivanandan, R, Soo, KC. Pattern of cervical lymph node metastases from papillary carcinoma of the thyroid. Br J Surg 2001;88:1241–4CrossRefGoogle ScholarPubMed
Dijkstra, PU, van Wilgen, PC, Buijs, RP, Brendeke, W, de Goede, CJ, Kerst, A et al. Incidence of shoulder pain after neck dissection: a clinical explorative study for risk factors. Head Neck 2001;23:947–53CrossRefGoogle ScholarPubMed
Pandey, M, Karthikeyan, S, Joshi, D, Kumar, M, Shukla, M. Results of a randomized controlled trial of level IIb preserving neck dissection in clinically node-negative squamous carcinoma of the oral cavity. World J Surg Oncol 2018;16:219CrossRefGoogle ScholarPubMed
Patten, C, Hillel, AD. The 11th nerve syndrome. Accessory nerve palsy or adhesive capsulitis? Arch Otolaryngol Head Neck Surg 1993;119:215–20CrossRefGoogle ScholarPubMed