Pattern And Predictive Factors Of Regional Lymph Node Metastasis In Papillary Thyroid Carcinoma

Aim：Papillary thyroid carcinoma (PTC) is the most common thyroidcancer, with a predilection for lymphatic spread. Without a clearunderstanding of nodes at risk, the strategy on how best to manage the neckis difficult. The objectives of this retrospective study were to evaluate thepattern and predictive factors of cervical LNM, and to determine the optimallymph node management strategy.Methods: Between February2010and February2013,96patients wereretrospectively analyzed who underwent surgical treatment for PTC at ourhospital. All patients underwent neck dissection of the central and lateralcompartments. Neck dissection specimens were marked, separatedaccording to neck levels and sent for pathology examination.Results: Overall,63patients (65.6%) had nodal metastases to level VI,57(59.4%) to level III，42(43.8%) to level II,35(36.5%) to level Ⅳ,8(8.2%) to level V.19(19.8%) had a skip metastasis. Only3patients hadmetastases to the contralateral compartments. male sex and extracapsularinvasion were significant predictive factors of cervical LNM (P<0.05each), and central LNM was significantly related to lateral LNM（P=0.002）.Conclusions:Ipsilateral central lymph node dissection (LND) isrecommended for all PTC patients because the rate of lymph node metastasisis high. If no evidence of level I and level V LNM, therapeutic lateral LNDcan be confined to levels II to IV. If central lymph nodes are involved,surgeons must carefully inspect the lateral lymph nodes.