Lateral neck metastases in papillary thyroid carcinoma

Abstract

Lateral lymph node metastases occur in 30–80% of papillary thyroid carcinoma patients. It is generally accepted that they do not impact the overall survival but are identified as an independent risk factor for locoregional recurrence. However, their significance is still not clearly understood. The aim of this study is to analyse metastasizing to the lateral neck levels in a cohort of patients with papillary thyroid carcinoma and lateral neck metastases, and also to assess the recurrence rate through regular check-ups. Methods: We prospectively analysed the data of 135 patients who underwent total thyroidectomy with selective neck dissection (levels II–VI), from 2011 to 2020. We analysed demographics and clinical characteristics of patients and assessed their correlation. Patients were followed up until April 2021. The median follow-up period was 62 months. Patients were followed up through regular check-ups and hospital records. Results: The median age was 36.8 years, 28 percent were men. The most frequently affected neck levels were III, IV, II, and V, respectively. Primary tumours larger than one cm displayed a higher number of positive lymph nodes, while extracapsular spread was revealed to be an independent risk factor for a higher number of positive lymph nodes. During a median follow-up period of 62 months, 18 (13.3%) patients developed regional recurrence of the disease, while two patients (1.2%) developed distant metastases.The mean disease-free period was 16.7 months. Conclusion: Lateral neck metastases occur in predictable patterns. The most frequently affected neck level was III, followed by IV. In two-thirds of the patients, metastases were found in multiple lateral neck levels. Tumour size and extracapsular spread show association with a higher number of positive lymph nodes, and with the higher number of positive nodes in patients with extracapsular spreading. Considering the recurrence rate in the follow-up period, we can conclude that selective neck dissection of levels II–VI proved to be an optimal treatment modality for such patients.

Keywords

• thyroid cancer
• papillary – pathology
• surgery; lymph nodes – pathology
• surgery; lymphatic metastasis – pathology; neck dissection –methods; thyroidectomy; neoplasm recurrence