Lateral cervical lymph node metastases in papillary thyroid cancer: a systematic review of imaging‐guided and prophylactic removal of the lateral compartment

Abstract

Metastatic cervical LNs were found in more than half of patients when prophylactic lateral LN dissection was performed. Use of conventional imaging for the selection of the surgical approach to the lateral cervical compartment may commonly identify stage N1a instead of N1b and thus lead to false stage assignment as stage III rather than stage IV, concealing the severe prognostic implications of this stage progression in individual patients.

Impact of prophylactic central neck dissection on oncologic outcomes of papillary thyroid carcinoma: a review

“…The accuracy of ultrasound in the central compartment improves once the thyroid has been removed, in the follow-up setting. Ultrasound appears to have a higher sensitivity, ranging from 27 to 85 %, for the detection of lateral LNM with high variability among studies (LE 4) [45, 50]. Even with recent technological improvements in ultrasonography, the current preoperative evaluation of the central and lateral neck compartments is not as sensitive or specific as PND [48, 51].…”

“…Among the proponents of PND, there is also debate regarding the type of PND that should be performed (i.e., unilateral or bilateral PND of the central compartment) [50, 55]. Unilateral central compartment PND is performed in many centers with no worse outcome as compared to bilateral central PND.…”

Efficacy of Superselective Neck Dissection in Detecting Metastasis in Patients with cN0 Papillary Thyroid Carcinoma at High Risk of Lateral Neck Metastasis

“…According to the TNM staging system, the presence of lateral neck metastasis is classified as N1b and patients with N1b cancer and aged >45 years old are classified IV. Compared to the watch and wait approach [10,21,22], some clinicians are more proactive and perform lateral neck dissection [4,6,16,23]. Lateral neck dissection is already recommended by Japanese guidelines [24].…”

“…Recently, it was also applied to thyroid cancer for early diagnosis and treatment [7,26,27] because the results of radiological examinations and FNA guided by B-mode ultrasound were not satisfactory [28,29]. The sensitivity of ultrasound and CT for the detection of lateral neck metastases is poor (27%) [4]. Kang concluded that patients with image-based, isolated lateral Level IV involvement and no macroscopic extra nodal extension are potential candidates for limited Levels III–IV dissection [9].…”

“…Indeed, the rates of cervical LN and occult metastasis (metastasis undetectable by routine methods) to the lateral neck in thyroid cancer reportedly reach astounding high rates of 80% and 50%, respectively [4]. However, the value and treatment principles of LN metastasis, especially in the lateral neck, remain controversial.…”