title: Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection.
abstract: OBJECTIVE
  To determine the frequency and pattern of lymph node metastasis (LNM) from papillary thyroid microcarcinoma (PTMC) and the results of node dissection, and to establish the optimal strategy for neck dissection in these patients.
  
  
  BACKGROUND
  Most PTMCs carry a favorable prognosis, but a few present with palpable lymphadenopathy. Patients with LNM are at risk for nodal recurrence, although they do not have higher mortality. The frequency and pattern of LNM from PTMC and the results of node dissection are not well established.
  
  
  METHODS
  The frequency and pattern of LNM from 259 PTMCs were analyzed according to the size and location of the primary tumor. Of the 259, 24 with palpable nodes underwent therapeutic node dissection and the other 235 patients without palpable nodes underwent prophylactic node dissection. The authors compared the results of node dissection between the therapeutic group and the prophylactic group, and between PTMCs 5 mm or smaller and PTMCs larger than 5 mm. The authors also compared nodal recurrence between the prophylactic group and a no-lymph-node-dissection group (155 PTMCs).
  
  
  RESULTS
  Overall, 64.1% (166/259) and 44.5% (93/209) had node involvement of the central and ipsilateral lateral compartment, respectively. Pretracheal (43.2%), ipsilateral central (36.3%), and ipsilateral mid-lower (37.8%) jugular were more commonly involved. LNM was more frequent in the therapeutic group than in the prophylactic group (95.8% vs. 60.9% for central compartment, 83.3% vs. 39.5% for ipsilateral lateral compartment). Nodal recurrence was more common in the therapeutic group than in the prophylactic group (16.7% vs. 0.43%), but did not differ between the prophylactic group and the no-dissection group (0.43% vs. 0.65%). The tumor size did not influence nodal recurrence. Nodal recurrence preferentially occurred in ipsilateral mid-lower jugular nodes.
  
  
  CONCLUSIONS
  Patients who have PTMC presenting with palpable lymphadenopathy should have therapeutic node dissection. Prophylactic node dissection is not beneficial in those without palpable lymphadenopathy.
authors.affiliation: First Department of Surgery, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Wada
authors.forename: Quan-Yang
authors.initials: QY
authors.lastname: Duh
authors.forename: Kiminori
authors.initials: K
authors.lastname: Sugino
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Iwasaki
authors.forename: Kaori
authors.initials: K
authors.lastname: Kameyama
authors.forename: Takashi
authors.initials: T
authors.lastname: Mimura
authors.forename: Koichi
authors.initials: K
authors.lastname: Ito
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takami
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Takanashi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002291:Carcinoma, Papillary / Q000473:pathology / Q000556:secondary*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy