Level IIb neck dissection guided by fine-needle aspiration for N1b papillary thyroid carcinoma |
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| Affiliation: | 1. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, Beijing, China;2. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, China;1. First Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, “Alexandra” General Hospital, Athens, Greece;2. First Department of Propaedeutic Surgery, National Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece;3. Department of Anesthesiology, “Alexandra” General Hospital, Athens, Greece;1. Haematology Laboratory-Unit of Molecular Biology, University Hospital of Ioannina, Ioannina, Greece;2. Neurosurgical Institute, University of Ioannina School of Medicine, Ioannina, Greece;3. Breast Unit, University Hospital of Ioannina, Greece;4. 3P-Medicine Laboratory, Medical University of Gdańsk, Gdańsk, Poland;5. Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece;1. Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Faculty of Medicine and University Hospital Kerpener Strasse 62, 50937, Cologne, Germany;2. School of Medicine, University of Cologne, Cologne, Germany Albertus-Magnus-Platz, 50923, Cologne, Germany;3. Institute of Pathology, University of Cologne, Faculty of Medicine and University Hospital Kerpener Strasse 62, 50937, Cologne, Germany;4. Institute of Pathology of the Medical Campus Bodensee Roentgen Strasse 2, 88048, Friedrichshafen, Germany;1. Section of Endocrine Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA;2. Section of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA;3. Yale-New Haven Hospital, Yale University School of Medicine, 330 Cedar Street, FMB 102, PO Box 208062, New Haven, CT 06520–8062, USA |
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| Abstract: | ![]()
BackgroundThe extent of neck dissection for patients with papillary thyroid carcinoma (PTC) metastasis in lateral cervical lymph nodes is still debated. Studies aiming to omit level IIb were generally based on postoperative histopathologic information. The purpose of this study was to evaluate the predictive value of fine-needle aspiration (FNA) for level II lymph nodes in identifying candidates for neck dissection sparing level IIb before surgery.MethodsWe prospectively enrolled 156 consecutive previously untreated PTC patients with lateral neck metastases who were subjected to 178 therapeutic lateral neck dissections (including level IIa, IIb, III, IV, and Vb) between June 2018 and August 2021. Ultrasound-guided FNA of suspicious lymph nodes at level II was preoperatively performed. The cytology of FNA and thyroglobulin (Tg) washout concentration with other clinical predictors was analyzed for lymph node metastases at level IIb.ResultsPreoperative ultrasonography revealed suspicious lymph nodes at level II in 118 cases, and fifty were positive on FNA results. Metastasis at level IIb was seen in 17 (9.6%) of the postoperative specimens. By univariate analysis, the rate of level IIb metastasis was significantly higher in patients with FNA-positive lymph nodes at level II (P<0.001, odds ratio = 16.899). The tumor sizes of the two FNA-negative level IIb metastatic lymph nodes were 0.4 mm and 3 mm.ConclusionsLevel IIb lymph node dissection may be omitted in the treatment of N1b PTC patients if FNA to level II lymph nodes is negative. |
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| Keywords: | Papillary thyroid carcinoma Lateral lymph node metastasis Neck dissection Fine-needle aspiration |
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