The Influence Factors Of Level V Lymph Node Metastasis In Patients With Papillary Thyroid Carcinoma And The Extent Of Neck Dissection (Clinical Analysis Of102Patients)

Objective Currently，the extent of lateral neck dissection for clinically evidentnodal metastases in the lateral neck in a patient with papillary thyroid carcinoma (PTC)continues to remain controversial. The aim of this study was to compare the diagnosticefficiency of preoperative ultrasonography and preoperative CT. And from this studywe examined the pattern of neck lymph node metastasis and identify predictors of levelV involvement in patients with PTC.Methods We reviewed retrospectively the medical records between January2010and January2013of102patients with PTC who underwent modified radical lateralneck dissections (level II--V). No patient in the study had a clinically positive level Vlymph node. Compared the preoperative results of Ultrasonography and CT with theafteroperative results of pathological sections. We analyse the cervical lymph nodemetastasis of these patients. To contradistinguish patients with histopathologicallynegative level V nodes and patients with histopathologically positive level V nodes fortwo groups of antithesis.And clinical and histopathological factors that predicted levelV metastasis were identified for Chi-square test.Results The sensitivity of Color Doppler Ultrasonography was88.9%; thesensitivity of CT was48.1%.Eighty-two（80.3%），49（48.0%）,69（67.6%） and61（59.8%）patients had histologically positive lymph nodes in levels VI, II, III, and IV,espectively. Occult metastases in level V were observed in22(21.6%) patients.Chi-square test showed that the presence of ipsilateral level V metastases wassignificantly associated with male sex(p <.05),multifocal disease (p <.05), Capsularinvasion (p <.05), ipsilateral level IV (p <.05), and simultaneous involvement of ipsilateral levels II–IV metastasis (p <.01).. Age, ipsilateral level II, ipsilateral levelIII,size of primary tumor, location of primary tumor and contralateral lymph nodemetastases were not found to be associated with level Vmetastases.Conclusions1. Ultrasonography was more sensitive than CT.2. The common pattern of ipsilateral lymph node metastasis in a patient withpapillary thyroid carcinoma was migrating to cervical lymph node in the first, then toLateral neck lymph node. Skip-metastase was rare.3. This study demonstrated that nearly80%afteroperative results of pathologicalsectionsoccult to level V in patients was negative. We believe that routine dissection ofthe level V lymph nodes should be unnecessary for patients with clinically negativelevel V lymph node from papillary thyroid cancer. A patient who have been clinicallyevidented nodal metastases in the lateral neck（levels II–IV） with multifocal cancer orcapsular invasion or nodal metastases in level IV or simultaneous involvement ofipsilateral levels II–IV may have a higher risk of harboring metastatic disease at level V,especially, a male.