Abstract
The suprasternal space is a narrow space between the superficial and deep layers of the investing layers of the deep cervical fascia above the manubrium of the sternum. The suprasternal space has been paid little attention as a space with the potential for lymph node metastasis from both thyroid cancer and head and neck cancer. We experienced 2 patients who were found to have a lymph node in the suprasternal space preoperatively. Both of them had well-differentiated thyroid papillary carcinomas and level III and IV lymph node metastases as well as metastasis in the suprasternal space. We have not previously dissected the suprasternal space prophylactically in other patients with thyroid papillary cancer, but no patient has developed metastasis in this space to date. The suprasternal space is not usually dissected in patients with thyroid cancer. However, suprasternal space metastasis has been reported to occur occasionally in patients with lymph node metastases in levels III and IV. We consider that dissection of the suprasternal space, which is not routinely performed, should be done when preoperative examination suggests lymph node metastasis in the suprasternal space as dissection of this space is less invasive, easy to achieve, and is not time consuming. Greater attention should be paid to the suprasternal space as an area with the potential for lymph node metastasis from thyroid cancer.
References
Standring S (2008) Gray’s anatomy: the anatomical basis of clinical practice, expert consult, 40th edn. Churchill Livingstone, UK
Sun G, Wang Y, Zhu Y et al (2013) Lymph node metastasis between sternocleidomastoid and sternohyoid muscle in clinically node-positive papillary thyroid carcinoma. Head Neck 35:1168–1170
Robbins KT, Ronen O (2009) Neck dissection classification. In: Ferlito A, Robbins KT, Silver CE (eds) Neck dissection: management of regional disease in head and neck cancer. Plural Publishing, San Diego, pp 41–51
Roh JL, Kim JM, Park CI (2008) Central cervical nodal metastasis from papillary thyroid microcarcinoma: pattern and factors predictive of nodal metastasis. Ann Surg Oncol 15:2482–2486
Shaha AR, Shah JP, Loree TR (1997) Low-risk differentiated thyroid cancer: the need for selective treatment. Ann Surg Oncol 4:328–333
Sanders LE, Cady B (1998) Differentiated thyroid cancer: reexamination of risk groups and outcome of treatment. Arch Surg 133:419–425
Hollinshead WH (1982) Fascia and fascial spaces of the head and neck. Anatomy for surgeons, vol 1, 3rd edn. Harper & Row, Philadelphia, pp 269–289
Acknowledgments
This study was supported in part by a Health and Labour Sciences Research Grant for Clinical Cancer Research (H22-Gannrinshou-Ippan-017) from the Ministry of Health, Labour and Welfare of Japan, the National Cancer Center Research and Development Fund (23-A-21) of Japan, and a grant-in-aid for Scientific Research (C) (KAKENHI 24592587) from the Ministry of Education, Culture, Sports, Science, and Technology of Japan.
Conflict of interest
All of the authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Homma, A., Hatakeyama, H., Mizumachi, T. et al. Lymph node metastasis in the suprasternal space from thyroid papillary cancer. Int Canc Conf J 4, 57–60 (2015). https://doi.org/10.1007/s13691-014-0171-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13691-014-0171-9