title: Contralateral cervical and mediastinal lymph node metastasis in medullary thyroid cancer: systemic disease?
abstract: BACKGROUND
  The current American Joint Committee on Cancer/International Union Against Cancer classification designates cervical and mediastinal lymph nodes as regional lymph nodes. In a unilateral thyroid neoplasm, however, involvement of the contralateral cervical lymph node compartment or the mediastinal lymph node compartment, both of which have been designated "distant" lymph nodes, may serve as a surrogate parameter of distant metastases.
  
  
  METHODS
  This institutional series consisted of 105 consecutive patients with medullary thyroid cancer who underwent systematic dissections of both distant lymph node compartments.
  
  
  RESULTS
  Thirty-eight patients had no distant lymph node metastasis, 36 patients had involvement of only 1, and 31 patients of both distant lymph node compartments. Significant associations (P < .001) were seen on univariate analysis between the number of involved "distant" lymph node compartments (none, one, or both) and extrathyroidal extension (3%, 33%, and 58%), the number of positive lymph nodes (means of 3, 13, and 33), and distant metastasis (8%, 36%, and 61%). In a multivariate logistic regression model, only involvement of one or both "distant" lymph node compartments (versus no distant lymph node metastasis) remained significantly related to distant metastasis in a dose-dependent fashion.
  
  
  CONCLUSIONS
  "Distant" lymph nodes in medullary thyroid cancer should be regarded as nonregional lymph nodes because their involvement is indicative of distant metastasis.
authors.affiliation: Departments of General, Visceral and Vascular Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06097 Halle/Salle, Germany. gensurg@medizin.uni-halle.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Machens
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Holzhausen
authors.forename: Henning
authors.initials: H
authors.lastname: Dralle
mesh_terms: D005260:Female; D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum; D009333:Neck; D013964:Thyroid Neoplasms / Q000473:pathology*