Preoperative detection and predictors of level V lymph node metastasis in patients with papillary thyroid carcinoma
- Preoperative detection and predictors of level V lymph node metastasis in patients with papillary thyroid carcinoma
- M. J. Shim; J.-L. Roh; G. Gong; K.-J. Cho; J. H. Lee; S.-H. Choi; S. Y. Nam; 김상윤
- Issue Date
- British journal of surgery : BJS
- VOL 100, NO 4, 497-503
- Background: Papillary thyroid carcinoma (PTC) frequently metastasizes to regional lymph nodes.
Metastasis to the posterior neck, level V, is uncommon, and level V lymphadenectomy may lead to spinal
accessory nerve injury and associated postoperative morbidities. The aim of this study was to assess the
diagnostic efficiency of preoperative ultrasonography and to identify predictors of level V metastasis in
patients with PTC.
Methods: This study involved patients with previously untreated PTC that had metastasized to the lateral
neck, and who underwent total thyroidectomy with central and lateral neck dissection. Histopathological
findings were compared with ultrasound results for various neck levels. Clinical and histopathological
factors that predicted level V metastasis were identified.
Results: Of 143 patients, 26 (18·2 per cent) had lymph node metastasis at level V. The sensitivity
and positive predictive value of ultrasonography for level V metastasis were 46·2 and 30·0 per cent
respectively. Univariable analysis showed that male sex, extranodal disease extension, a metastatic lymph
node ratio in the ipsilateral lateral neck of more than 0·2, and simultaneous involvement of ipsilateral
levels II.IV or level III were associated with ipsilateral level V metastasis. Multivariable analysis revealed
an independent association between macroscopic extranodal disease extension and level V metastasis
(odds ratio 26·05, 95 per cent confidence interval 5·63 to 120·56; P < 0·001).
Conclusion: Preoperative ultrasonography frequently failed to detect level V metastasis in patients with
metastatic PTC. Level V lymphadenectomy may be considered in patients with lymph node metastasis
in the ipsilateral lateral neck with macroscopic extranodal extension.
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