Is Routine Dissection of Level II‐B and V‐A Necessary in Patients with Papillary Thyroid Cancer Undergoing Lateral Neck Dissection for FNA‐Confirmed Metastases in Other Levels

Abstract

Cervical lateral neck metastases in PTC occur in a predictable pattern, with levels III, II-A, and IV most commonly involved. Patients with PTC who undergo lateral neck dissection for FNA-confirmed nodal metastases might harbor disease in level II-B, especially if level II-A is involved. We recommend elective dissection of level II-B only when level II-A is involved, based on FNA confirmation, or when it is grossly involved on intraoperative evaluation. Routine dissection of level V-B is recommended in this patient population, while elective dissection of level V-A is not necessary.

Risk factors for level V lymph node metastases in solitary papillary thyroid carcinoma with clinically lateral lymph node metastases

“…Therefore, determining a rational extent of therapeutic LND is vital. Whether level V should be included in therapeutic LND continues to be debated 16, 17, 18, 19, 20, 21, 22. A majority of previous studies had explored some predictors for level V LNM in PTC patients with clinically LLNM, but only a few studies have explored the risk factors for level V LNM in solitary PTC with clinically LLNM.…”

“…On the basis of the above reasons and the prognostic significance, it is universally agreed that therapeutic LND should include at least a comprehensive but selective LND of levels II–IV. However, whether therapeutic LND should routinely include level V lymphadenectomy remains controversial 13, 14, 15, 16, 17, 18, 19, 20, 21, 22.…”

“…Furthermore, because level V LNM are comparatively rare, some researchers have suggested that routine level V dissection is not necessary for patients with PTC and lateral cervical lymphadenopathy 16, 17, 18. However, others hold the opposite view according to the high rates of metastasis seen with this cancer 19, 20, 21, 22. On the basis of the comparatively low frequency of level V LLNM in this study and the risk of postoperative complications, we propose that therapeutic LND should not routinely include level V lymphadenectomy except when level V LLNM is suspected on the basis of preoperative examination, such as US and CT, or there are associated risk factors.…”

“…However, it is debatable whether routine level V lymphadenectomy is necessary in patients with PTC with clinically LLNM 16, 17, 18, 19, 20, 21, 22. In addition, there have been few studies to explore the risk factors for level V LNM in solitary PTC with clinically LLNM.…”

Level V Lymph Node Dissection in PTMC Patients: Is This Necessary?

“…Accordingly, the authors concluded, in the setting of prophylactic lateral ND, that level Va dissection is unnecessary. (15) In a study of range of level V dissection, Farrag et al (16) recommended that routine level Va dissection is unnecessary. Cervical lateral neck metastases in PTC were found to occur in a predictable pattern, and levels III, IIa, and IV were most commonly involved.…”