Is it possible to rule out level II and level VB dissection in patients with metastatic papillary thyroid cancer?
BackgroundThe completeness of surgical resection is a key factor influencing outcomes in patients with papillary thyroid carcinoma (PTC) and regional lymph node metastases. However, the optimal extent of therapeutic lateral neck dissection remains a matter of debate This study aimed to assess the di...
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Frontiers Media S.A.
2025-08-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2025.1520539/full |
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| author | Tugba Matlim Ozel Sezer Akbulut Aykut Celik Gorkem Yildiz Hamit Yucel Barut Fatih Mert Dogukan Serkan Sari |
| author_facet | Tugba Matlim Ozel Sezer Akbulut Aykut Celik Gorkem Yildiz Hamit Yucel Barut Fatih Mert Dogukan Serkan Sari |
| author_sort | Tugba Matlim Ozel |
| collection | DOAJ |
| description | BackgroundThe completeness of surgical resection is a key factor influencing outcomes in patients with papillary thyroid carcinoma (PTC) and regional lymph node metastases. However, the optimal extent of therapeutic lateral neck dissection remains a matter of debate This study aimed to assess the diagnostic accuracy of preoperative ultrasonography (US) in detecting lateral lymph node metastasis (LLNM) in patients with PTC and to identify clinical and pathological factors predictive of metastases at levels II and V.MethodsThis retrospective study included consecutive patients with PTC who underwent comprehensive lateral neck dissection at a single tertiary center between June 2020 and July 2024.ResultsIn 63 patients, a total of 78 comprehensive lateral neck dissections were performed. Of the patients, 41 (65%) were male and 22 (35%) were female, with a median age of 37 years (range, 24–49 years). Lymph node metastases were identified in 46 (58.9%), at level II, 561 (78.2%) at level III, 60 (76.9%) at level IV, and 9 (11.5%) at level Vb. Metastasis to level IIb was detected in 5 dissections. Among the 9 patients with level Vb metastases, 7 (77.8%) had involvement of four different cervical levels. The specificity of US in identifying metastatic disease was notably high at both level II (80%) and level Vb (87%). Independent predictors of metastatic involvement at level II and level Vb lymph nodes was associated with extrathyroidal extension [level II: odds ratio (OR) 7.88, p=0.03; level V: OR 6.91, p=0.043] and a largest metastatic lateral lymph node size above 2 cm [level II: OR 18.58, p=0.03; level V: OR 11.32, p=0.03].ConclusionRoutine dissection of level IIa is recommended in N1b PTC due to high metastasis rates. However, level IIb dissection may be omitted in selected cases given its low metastasis rate and potential morbidity, with intraoperative frozen section serving as a useful guide. Similarly, level Vb dissection may be avoided when lateral lymph nodes are <2 cm, multilevel involvement is absent, and ultrasonographic findings are negative. |
| format | Article |
| id | doaj-art-57c40cdf61f14b32bca51ece88b50ae2 |
| institution | DOAJ |
| issn | 1664-2392 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Endocrinology |
| spelling | doaj-art-57c40cdf61f14b32bca51ece88b50ae22025-08-20T02:58:11ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922025-08-011610.3389/fendo.2025.15205391520539Is it possible to rule out level II and level VB dissection in patients with metastatic papillary thyroid cancer?Tugba Matlim Ozel0Sezer Akbulut1Aykut Celik2Gorkem Yildiz3Hamit Yucel Barut4Fatih Mert Dogukan5Serkan Sari6Division of Endocrine Surgery, Department of General Surgery, University of Health Sciences Turkey, Basaksehir Cam and Sakura City Hospital, Istanbul, TürkiyeDivision of Endocrine Surgery, Department of General Surgery, University of Health Sciences Turkey, Basaksehir Cam and Sakura City Hospital, Istanbul, TürkiyeDivision of Endocrine Surgery, Department of General Surgery, University of Health Sciences Turkey, Basaksehir Cam and Sakura City Hospital, Istanbul, TürkiyeDivision of Endocrine Surgery, Department of General Surgery, University of Health Sciences Turkey, Basaksehir Cam and Sakura City Hospital, Istanbul, TürkiyeDepartment of Radiology, University of Health Sciences Turkey, Basaksehir Cam and Sakura City Hospital, Istanbul, TürkiyeDepartment of Pathology, University of Health Sciences Turkey, Basaksehir Cam and Sakura City Hospital, Istanbul, TürkiyeDivision of Endocrine Surgery, Department of General Surgery, University of Health Sciences Turkey, Basaksehir Cam and Sakura City Hospital, Istanbul, TürkiyeBackgroundThe completeness of surgical resection is a key factor influencing outcomes in patients with papillary thyroid carcinoma (PTC) and regional lymph node metastases. However, the optimal extent of therapeutic lateral neck dissection remains a matter of debate This study aimed to assess the diagnostic accuracy of preoperative ultrasonography (US) in detecting lateral lymph node metastasis (LLNM) in patients with PTC and to identify clinical and pathological factors predictive of metastases at levels II and V.MethodsThis retrospective study included consecutive patients with PTC who underwent comprehensive lateral neck dissection at a single tertiary center between June 2020 and July 2024.ResultsIn 63 patients, a total of 78 comprehensive lateral neck dissections were performed. Of the patients, 41 (65%) were male and 22 (35%) were female, with a median age of 37 years (range, 24–49 years). Lymph node metastases were identified in 46 (58.9%), at level II, 561 (78.2%) at level III, 60 (76.9%) at level IV, and 9 (11.5%) at level Vb. Metastasis to level IIb was detected in 5 dissections. Among the 9 patients with level Vb metastases, 7 (77.8%) had involvement of four different cervical levels. The specificity of US in identifying metastatic disease was notably high at both level II (80%) and level Vb (87%). Independent predictors of metastatic involvement at level II and level Vb lymph nodes was associated with extrathyroidal extension [level II: odds ratio (OR) 7.88, p=0.03; level V: OR 6.91, p=0.043] and a largest metastatic lateral lymph node size above 2 cm [level II: OR 18.58, p=0.03; level V: OR 11.32, p=0.03].ConclusionRoutine dissection of level IIa is recommended in N1b PTC due to high metastasis rates. However, level IIb dissection may be omitted in selected cases given its low metastasis rate and potential morbidity, with intraoperative frozen section serving as a useful guide. Similarly, level Vb dissection may be avoided when lateral lymph nodes are <2 cm, multilevel involvement is absent, and ultrasonographic findings are negative.https://www.frontiersin.org/articles/10.3389/fendo.2025.1520539/fulllateral lymph node metastasislevel V dissectionlevel II dissectionthyroid cancerlateral lymph node dissectionneck dissection |
| spellingShingle | Tugba Matlim Ozel Sezer Akbulut Aykut Celik Gorkem Yildiz Hamit Yucel Barut Fatih Mert Dogukan Serkan Sari Is it possible to rule out level II and level VB dissection in patients with metastatic papillary thyroid cancer? Frontiers in Endocrinology lateral lymph node metastasis level V dissection level II dissection thyroid cancer lateral lymph node dissection neck dissection |
| title | Is it possible to rule out level II and level VB dissection in patients with metastatic papillary thyroid cancer? |
| title_full | Is it possible to rule out level II and level VB dissection in patients with metastatic papillary thyroid cancer? |
| title_fullStr | Is it possible to rule out level II and level VB dissection in patients with metastatic papillary thyroid cancer? |
| title_full_unstemmed | Is it possible to rule out level II and level VB dissection in patients with metastatic papillary thyroid cancer? |
| title_short | Is it possible to rule out level II and level VB dissection in patients with metastatic papillary thyroid cancer? |
| title_sort | is it possible to rule out level ii and level vb dissection in patients with metastatic papillary thyroid cancer |
| topic | lateral lymph node metastasis level V dissection level II dissection thyroid cancer lateral lymph node dissection neck dissection |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2025.1520539/full |
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