Patterns of Cervical Lymph Node Metastases in Primary and Recurrent Papillary Thyroid Cancer

The incidence of thyroid cancer is rising in the United States with papillary thyroid cancer (PTC) being the most common type. We performed a retrospective study of 49 patients with PTC who underwent 57 lateral neck dissections (NDs). The extent of NDs varied, but 29 of 57 (51%) consisted of levels II-V. Twelve of 57 (21%) NDs consisted of levels I-V. Twelve of 57 (21%) NDs consisted of levels II-IV. One of 57 (1.8%) necks involved only levels I-IV. One of 57(1.8%) necks involved only levels I-V. One of 57(1.8%) necks involved only levels III-V. Two (3.5%) double-level (III-IV) neck surgeries were also performed. Metastatic PTC adenopathy was confirmed pathologically in 2%-level-I, 45%-level-II, 57%-level-III, 60%-level-IV, and 22%-level-V necks. Level-V was positive in 21% of primary and 24% of recurrent groups (P = 0.76). Comparing primary and recurrent disease, there was no difference in nodal distribution or frequency for levels I, II, III, and V. Level-IV was more common in the recurrent cases (P = 0.05). Based on the pathologic distribution of nodes, dissection should routinely include levels II-IV and extend to level-V in primary and recurrent cases. Our data does not suggest routine dissection of level-I.