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Predictive Factors of Level IIb Lymph Node Metastasis in Patients with Papillary Thyroid Carcinoma

  • Head and Neck Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The extent of neck dissection (ND) appropriate for necks yielding clinical evidence of metastases of papillary thyroid carcinoma (PTC) is controversial. The need for Ievel IIb lymph node (LN) dissection is particularly uncertain in view of its association with postoperative shoulder dysfunction. In the present study, we examined the frequency, pattern, and predictive factors of level IIb LN metastases in PTC patients with clinically positive lateral neck nodes.

Methods

We reviewed the medical records of 76 PTC patients who underwent therapeutic lateral ND for the treatment of clinically positive lateral neck nodes between March 2005 and July 2008. ND specimens were separately obtained for analyzing LN involvement with respect to neck level.

Results

Metastatic disease at levels II, III, IV, and V, was seen in 40 (52.6%), 55 (72.4%), 52 (68.4%), and 12 (15.8%) of the patients, respectively. The metastasis rate in level IIb was 11.8% (9 of 76). By univariate analysis, the rate of level IIb LN metastasis was significantly higher in patients with positive level IIa LNs and positive LNs in all lateral neck levels (levels IIa + III + IV) (P < .05). Multivariate analysis showed that positive LN involvement in all lateral neck levels (IIa + III + IV) was an independent predictive factor of level IIb LN metastasis (P = .044, odds ratio = 9.692).

Conclusions

Level IIb LN dissection may be omitted in the treatment of positive neck nodes in PTC patients if multilevel involvement including level IIa involvement is absent.

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Acknowledgment

This work was supported by the second phase of the Brain Korea 21 project.

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Authors and Affiliations

  1. Department of Otolaryngology, Head and Neck Surgery, Cancer Research Institute, Research Institute for Medical Sciences, Chungnam National University College of Medicine, Daejeon, Korea

    Bon Seok Koo MD & Yeo-Hoon Yoon MD

  2. Department of Pathology, Cancer Research Institute, Chungnam National University College of Medicine, Daejeon, Korea

    Jin-Man Kim MD

  3. Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea

    Eun Chang Choi MD & Young Chang Lim MD

  4. Department of Otorhinolaryngology, Head and Neck Surgery, Konkuk University, School of Medicine, Seoul, 143-752, Korea

    Young Chang Lim MD

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  1. Bon Seok Koo MD
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  2. Yeo-Hoon Yoon MD
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  3. Jin-Man Kim MD
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  4. Eun Chang Choi MD
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  5. Young Chang Lim MD
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Correspondence to Young Chang Lim MD.

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Koo, B.S., Yoon, YH., Kim, JM. et al. Predictive Factors of Level IIb Lymph Node Metastasis in Patients with Papillary Thyroid Carcinoma. Ann Surg Oncol 16, 1344–1347 (2009). https://doi.org/10.1245/s10434-009-0367-y

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  • DOI: https://doi.org/10.1245/s10434-009-0367-y

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