Study to Evaluate the Pattern of Nodal Distribution in Papillary Thyroid Cancer

Sunil Kumar Samdhani; Naresh Kumar Paliwal; Mahendra Singh Hada; Shraddha Sharma

doi:10.1007/s12070-023-03524-8

Study to Evaluate the Pattern of Nodal Distribution in Papillary Thyroid Cancer

Indian J Otolaryngol Head Neck Surg. 2023 Sep;75(3):1356-1362. doi: 10.1007/s12070-023-03524-8. Epub 2023 Feb 14.

Authors

Sunil Kumar Samdhani¹, Naresh Kumar Paliwal², Mahendra Singh Hada¹, Shraddha Sharma²

Affiliations

¹ Department of ENT, SMS Medical College and Hospital, Jaipur, Rajasthan India.
² Department of ENT, Ministry of Health and Family welfare, Pali, Rajasthan India.

PMID: 37636753
PMCID: PMC10447302 (available on 2024-09-01)
DOI: 10.1007/s12070-023-03524-8

Abstract

Among the thyroid cancers, papillary thyroid cancer (PTC) is the most common with lymphatic metastasis. It has the propensity to spread to the level II-VI lymph nodes in a predictable manner. We evaluated the pattern of nodal distribution at different levels of neck in papillary thyroid cancer in this Observational Prospective study. Total 41 patients of PTC (Papillary thyroid cancer) were included in the study. 36 out of them were diagnosed as PTC by FNAC and underwent total thyroidectomy and central neck dissection, while 5 patients were histologically confirmed cases of PTC on previous hemithyroidectomy and underwent completion thyroidectomy and central neck dissection .Patients with T3/T4 stage or N1 underwent lateral neck dissection also. Clinicopathological factors such as age, sex, tumor stage, nodal metastasis and extracapsular invasion, were evaluated. Lymph node metastasis was noted in 21 patients (51.2%) and all these patients had central (level VI) lymph node involvement. Among 21 patients, pathological ipsilateral lateral neck metastasis was noted in 6 patients (28.57%) at level II, 10 patients (47.62%) at level III and 8 patients (38.10%) at level IV. Only 5 patients (23.81%) had metastasis at level V. Extracapsular invasion was observed in 10 (24.4%) patients. We concluded that patients with PTC show higher rates of metastasis at central neck (level VI) and are not easily detected on clinical examination or by USG due to low sensitivity but are sensitive and specific for lateral neck nodes in late stages . Thus, ipsilateral selective neck dissection should be considered with total thyroidectomy and central neck dissection in presence of clinically or radiologically evident lateral lymph nodes (preoperatively) and in T3, T4 stage (late stages) tumors.

Keywords: Central neck; Lateral neck nodes; Lymphatics; Papillary thyroid cancer; Selective neck dissection.

© Association of Otolaryngologists of India 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.