Patterns of lateral and central neck lymph node metastasis in N1b papillary thyroid carcinoma / 中华普通外科杂志

ABSTRACT

Objective:To investigate the patterns of lateral and central neck lymph node metastasis in N1b papillary thyroid carcinoma (PTC) patients.Methods:From Jun 2018 to Sep 2020, 96 consecutive treatment-naive unilateral N1b PTC patients were included. After total thyroidectomy, bilateral central neck and unilateral lateral neck dissection (including the level Ⅱa, Ⅱb, Ⅲ, Ⅳ and Ⅴb) metastasis in different levels and pathological status of lymph nodes were analyzed.Results:The lymph node metastasis rates were 85% in ipsilateral paratracheal region, 82% in level Ⅲ, 77% in level Ⅳ, 55% in pre-tracheal region, 47% in contralateral paratracheal region, 40% in level Ⅱa, 34% in pre-laryngeal region, 6% in level Ⅱb, 6% in intermuscular region, 4% in level Ⅴb. Tumor size >1cm and pre-tracheal lymph nodes netastasis were associated with contralateral paratracheal metastasis ( OR=3.282 and 3.064, P<0.05); Metastasis to Ⅵa was associated with metastasis to Ⅵb ( OR=3.364, P<0.05). Conclusion:Level Ⅱa-Ⅳ of lateral neck and all subgroups of central neck lymph nodes tend to be involved in PTC with lateral neck metastasis. Lateral neck including level Ⅱa-Ⅳ and the whole central neck including right Ⅵb lymph nodes dissection is recommended for N1b PTC patients.