Level V in therapeutic neck dissections for papillary thyroid carcinoma |
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| Authors: | Avi Khafif MD Jesus E. Medina MD K.Thomas Robbins MD FRCSC Carl E. Silver MD Randal S. Weber MD Randall P. Owen MD MS Ashok R. Shaha MD Alfio Ferlito MD DLO DPath FRCSEd ad hominem FRCS ad eundem FDSRCS ad eundem FHKCORL FRCPath FASCP IFCAP |
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| Affiliation: | 1. Head and Neck Surgery and Oncology Unit, A.R.M. Center for Advanced Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel;2. Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma;3. Division of Otolaryngology–Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois;4. Departments of Surgery and Otolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York;5. Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas;6. Department of Surgery, Division of Metabolic, Endocrine and Minimally Invasive Surgery, Mount Sinai School of Medicine, New York, New York;7. Head and Neck Service, Memorial Sloan‐Kettering Cancer Center, New York, New York;8. ENT Clinic, University of Udine, Udine, Italy |
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| Abstract: | Neck dissection for papillary thyroid carcinoma (PTC) is the standard of care for patients with clinical evidence of regional metastases. However, the extent of neck dissection is debatable. The purpose of the current study was to develop evidence‐based recommendations for when to include level V, or 1 of its sublevels, among patients with PTC undergoing neck dissection. A literature review of all studies evaluating the occurrence of metastases in level V in patients with regional metastases from PTC undergoing neck dissection was performed. Occurrence of metastases at level V is low in most series (5% to 10%), although a wide range was noticed. In cases in which metastases were found at level V, they occurred almost exclusively at sublevel VB. Sublevel VA was rarely, if ever, involved with metastatic lymph nodes. However, only recently have investigators begun to specify which sublevels of level V are at risk. Therapeutic dissection of level V is indicated when there is clinical evidence of disease involving this zone. Elective dissection of sublevel VB is indicated when there is involvement of level IV, or possibly multiple nodes at levels II and III. Under these circumstances, dissection of sublevel VB is indicated but sublevel VA may be spared. © 2012 Wiley Periodicals, Inc. Head Neck, 2013 |
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| Keywords: | papillary thyroid carcinoma neck dissection level V sublevel VA sublevel VB |
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