Incidence of metastatic well-differentiated thyroid cancer in cervical lymph nodes

Arch Otolaryngol Head Neck Surg. 2004 Jan;130(1):110-3. doi: 10.1001/archotol.130.1.110.


Objective: To determine the incidence of clinically positive lateral cervical nodes at presentation and after initial treatment in patients with well-differentiated thyroid cancer.

Design: Retrospective chart review.

Setting: University-affiliated teaching hospitals.

Patients: A total of 508 patients who underwent a thyroidectomy as part of their initial treatment for well-differentiated thyroid carcinoma between January 1978 and December 1999. Neck dissections were performed only for clinically palpable cervical nodes.

Main outcome measures: Recurrence in the neck and survival.

Results: Forty-four patients (9%) had palpable lateral cervical lymph nodes at the time of surgery. All 31 patients younger than 45 years presenting with palpable positive nodes are alive and free of disease; 4 of 13 patients 45 years or older have died of thyroid cancer. Only 16 (3%) of 464 patients who did not undergo initial neck dissection had recurrence in lateral cervical nodes. Recurrence is more likely when the initial tumor is larger than 4 cm. In 216 patients younger than 45 years, there were 5 (2%) recurrences in lateral cervical nodes; these patients remain alive and free of disease. In 248 patients 45 years or older, there were 11 (4%) with recurrent disease in the lateral neck; 4 of these patients have died of thyroid cancer.

Conclusions: An aggressive approach to detecting and treating occult lateral cervical nodes by techniques such as jugular node sampling, sentinel node biopsy, or image-guided needle biopsy is not necessary in most patients. Attempts to detect and remove occult lateral cervical lymph node metastases might be considered in older patients with large primary tumors.

MeSH terms

  • Adult
  • Age Factors
  • Carcinoma / mortality
  • Carcinoma / pathology*
  • Female
  • Humans
  • Lymphatic Metastasis / pathology*
  • Male
  • Middle Aged
  • Neck
  • Retrospective Studies
  • Thyroid Neoplasms / mortality
  • Thyroid Neoplasms / pathology*
  • Thyroidectomy