Lymph Node Surgery for Thyroid Cancer


Level

Nodes

Lateral compartment

I

Submental and submandibular nodes

II

Deep cervical nodes from the skull base to the level of the hyoid. Further divided by the relationship to the accessory nerve (level 2a being medial and 2b lateral)

III

Deep cervical nodes from the level of the hyoid to the cricoid

IV

Deep cervical nodes from the level of the cricoid to the suprasternal notch

V

Posterior triangle nodes can be divided by their relationship to a plane drawn through the level of the cricoid cartilage (Va is above and Vb is below the accessory nerve)

Central compartment

VI

Pre- and paratracheal nodes from the level of the hyoid bone above to the sternal notch below and the carotid artery laterally

Mediastinal compartment

VII

Superior mediastinal nodes as far as the superior aspect of the brachiocephalic vein




Table 21.2
Lymph node staging





















NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Regional lymph node metastasis

N1a

Metastasis in level VI (pretracheal and paratracheal, including prelaryngeal and Delphian lymph nodes)

N1b

Metastasis in other unilateral, bilateral, or contralateral cervical or upper/superior mediastinal lymph nodes


Used with the permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010) published by Springer Science and Business Media LLC, www.​springer.​com



  • Nodal disease is usually ipsilateral but may be bilateral (30 %).


  • Lymph node metastases to the regional lymph nodes are relatively common in PTC and occur early on; the incidence of palpable neck disease is between 15 and 40 % (40–90 % have occult disease).


  • Metastases from follicular carcinoma are less common (<20 %).


  • Recurrent disease in lymph nodes accounts for 60–75 % of all neck recurrences.


  • Elderly patients and those with bilateral and mediastinal disease have a poorer prognosis.






      Lymphatic Drainage of the Thyroid


      Lymph node groups at the highest risk of metastases from DTC are in the central compartment (level VI), the lower jugular chain (levels III and VI), and the lower posterior triangle (level Vb) (Fig. 21.1).

      A270846_1_En_21_Fig1_HTML.jpg


      Fig. 21.1
      Lymph node levels of the neck (Reproduced with permission from Watkinson JC, Gilbert RW, Arnold H, editors. Stell and Maran’s textbook of head and neck surgery and oncology. 5th ed. London: Hodder Arnold; 2012. p. 433, Fig 23.12)


      A270846_1_En_21_Fig2_HTML.jpg


      Fig. 21.2
      Anterior view of the neck following central and lateral neck dissection

      Major drainage:



      • Middle jugular nodes – level III


      • Lower jugular nodes – level IV


      • Posterior triangle nodes – level Vb

    • Feb 26, 2017 | Posted by in ENDOCRINOLOGY | Comments Off on Lymph Node Surgery for Thyroid Cancer

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