Central compartment management in patients with papillary thyroid cancer presenting with metastatic disease to the lateral neck: Anatomic pathways of lymphatic spread

Likhterov, Ilya; Reis, Laura L. Dos; Urken, Mark L.

doi:10.1002/hed.24568

Cited by 44 publications

(49 citation statements)

References 16 publications

(29 reference statements)

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“…Besides, our study further examined the pattern of lateral multiple-level metastases and found that among 72 PTMC patients with lateral multiple-level metastases, the two-, three-, and four-level simultaneous metastases were detected in 38, 25, and nine patients, respectively. Levels III + IV simultaneous metastases were the most frequently involved in the lateral two-level metastases, which was consistent with the anatomy of lymphatic drainage in the area of the thyroid ( 26 ). The three-level metastases including levels II, III, and IV were the most common patterns in N1b PTMC patients.…”

Section: Discussionsupporting

confidence: 82%

“…Xiao et al ( 29 ) conducted ipsilateral LND for PTC patients and demonstrated that CPLN ≥ 2 was a reliable indicator of lateral LNM. Likhterov and colleagues ( 26 ) revealed that the incidence of lateral LNM significantly increased with the CPLN. Kim et al ( 24 ) have reviewed 658 N1b PTC patients and demonstrated that the bilateral central LNM (OR = 4.06, 95% CI: 2.29–7.18) and the unilateral central LNM (OR = 2.45, 95% CI: 1.53–3.92) were independent predictors for the lateral multilevel metastasis.…”

Section: Discussionmentioning

confidence: 99%

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Management of Lateral Multiple-Level Metastasis in N1b Papillary Thyroid Microcarcinoma

et al. 2020

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Background: The optimal extent of therapeutic lateral neck dissection (LND) in the management of N1b papillary thyroid microcarcinoma (PTMC) is still under debate in clinical practice. In this light, our study aims to explore the incidence, patterns, and predictive factors of the lateral multiple-level metastasis in N1b PTMC patients. Methods: The clinical records of 142 patients diagnosed with N1b PTMC who underwent therapeutic LND from July 2015 to November 2018 at our institution were retrospectively reviewed. Univariate and multivariate analyses were conducted to examine the predictive factors associated with lateral multiple-level metastasis. The recurrence-free survival was analyzed and confirmed by Kaplan–Meier plots and log-rank test. Results: The overall frequency of lateral multiple-level metastasis was 50.7% in N1b PTMC patients, and two-level to four-level simultaneous metastasis were present in 26.8, 17.6, and 6.3% patients, respectively. Extrathyroidal extension (ETE) (OR = 5.79, 95% CI, 1.36–24.59; P = 0.017) and the central metastatic lymph node ratio (CLNR) with values equal or higher than 0.61 (OR = 6.18, 95% CI, 2.53–15.09; P < 0.001) served as independent predictors of multiple-level metastasis in N1b PTMC patients. Moreover, locoregional recurrence was significantly higher in the selective neck dissection (SND) group compared to the modified radical neck dissection (MRND) one (HR = 3.65, 95% CI, 1.11–12.00; P = 0.03). Conclusion: Our results show that the lateral multiple-level metastasis was relatively common, and we suggest MRND to be considered for N1b PTMC patients with ETE or CLNR equal or higher than 0.61.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Management of Lateral Multiple-Level Metastasis in N1b Papillary Thyroid Microcarcinoma

et al. 2020

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“…The majority of lymphatic drainage follows the blood vessels that feed the gland. Ascending channels follow the superior thyroid artery and vein, draining the upper poles of the gland, while lymphatic drainage of the lower thyroid follows the inferior thyroid artery [20]. Since level VII lymph nodes were in anatomically continuous with level VI lymph nodes, it made sense that level VII LNM was associated with primary tumor location.…”

Section: Discussionmentioning

confidence: 99%

Identifying risk factors for metastasis to the level VII lymph node in papillary thyroid carcinoma patients

et al. 2020

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Background: The level VI lymph nodes are anatomically connected to the level VII lymph nodes and papillary thyroid carcinoma (PTC) can metastasis to both regions. The aim of this study was to identify clinicopathologic factors associated with level VII lymph node metastasis. Methods: Between March 2015 and September 2016, a total of 275 consecutive patients were operated on for PTC with prophylactic level VII dissection at the Sir Run Run . Patients with PTC were performed via video-assisted approach. Multivariate logistic regression analysis was performed to evaluate the associations between clinicopathologic factors. Results: Of the 275 subjects enrolled in this study, 79 patients (28.73%) showed lymph node metastasis to the level VII. The multivariate logistic regression analysis showed ultrasonography-positive lymph nodes (p < 0.001), the location of primary carcinoma (p = 0.002) and hashimoto thyroiditis (HT) (p = 0.04) were associated with level VII lymph node metastasis. Conclusions: Based on the results of our study, we considered central-compartment lymph node dissection (CLND) as an integral strategy. On the basis of surgery safety, transcervical level VII lymph node dissection could be considered for PTC patients with high risk factors such as ultrasonography-positive lymph nodes, tumor located in middle and lower thirds of the thyroid lobe and the patients without HT. In future, prognostic significance of level VII lymph node dissection should be evaluated through long-term surveillance.

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“…One drainage pathway is posterior to the carotid sheath and is responsible for level IV metastatic disease, whereas the other lymphatic pathways to the lateral neck can be found anterior to the carotid sheath. 13 The "Blood River" impedes the progress of lymph node metastasis. Because of the oblique BCT and right common carotid artery, RCSS became the "eyot" between the right carotid artery and the jugular vein and communicates with level VI and level IV through the areolar tissue, forming a "bridge" and "tunnel" across the "Carotid river" and under the "Jugular river," respectively.…”

Section: Discussionmentioning

confidence: 99%

Lymph node metastasis in the space between the right carotid artery and jugular vein in papillary thyroid carcinoma

et al. 2020

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Background The oblique brachiocephalic trunk and right common carotid artery constitute the right carotid sheath space (RCSS). The aim of this study was to detect the clinicopathologic factors associated with RCSS lymph node metastasis. Methods In total, 232 papillary thyroid carcinoma (PTC) patients with preoperative contrast-enhanced computed tomography scans were analyzed for associations between RCSS lymph node metastasis and clinicopathological factors. Results Among the 232 cases, 18 (7.76%) had suspicious RCSS lymph nodes, which was correlated with the presence of >5 metastatic lymph nodes, a larger thoracic inlet, and primary tumor size >2.15 cm. All pathologically confirmed metastatic lymph nodes were >1 cm in diameter. Conclusions The concept of “RCSS lymph node metastasis” was first introduced by this study. For PTC patients, a larger thoracic inlet, increased number of metastatic lymph nodes, and larger primary tumor size were related to RCSS lymph nodes, and more attention should be paid to patients who have lymph nodes >1 cm. A future prospective study will be designed to identify the potential risk factors for RCSS lymph node metastasis.

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Central compartment management in patients with papillary thyroid cancer presenting with metastatic disease to the lateral neck: Anatomic pathways of lymphatic spread

Abstract: PTC rarely spreads to the lateral neck without depositing metastases within the central neck. This finding is supported by the anatomic pathways for lymphatic spread, not previously highlighted in the English literature. © 2017 Wiley Periodicals, Inc. Head Neck 39: 853-859, 2017.

Cited by 44 publications

References 16 publications

Management of Lateral Multiple-Level Metastasis in N1b Papillary Thyroid Microcarcinoma

Management of Lateral Multiple-Level Metastasis in N1b Papillary Thyroid Microcarcinoma

Identifying risk factors for metastasis to the level VII lymph node in papillary thyroid carcinoma patients

Lymph node metastasis in the space between the right carotid artery and jugular vein in papillary thyroid carcinoma

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