title: Determining the extent of lateral neck dissection necessary to establish regional disease control and avoid reoperation after previous total thyroidectomy and radioactive iodine for papillary thyroid cancer.
abstract: BACKGROUND
  The purpose of this study was to evaluate patients who underwent lateral neck dissection for fine-needle aspiration (FNA)-confirmed disease after total thyroidectomy and radioactive iodine (RAI) to determine the appropriate extent of resection necessary to avoid reoperation.
  
  
  METHODS
  This study was conducted with a retrospective review of medical charts of 100 consecutive patients.
  
  
  RESULTS
  Seventy-seven percent of initial lateral neck dissection specimens and 64% of reoperative lateral neck dissection specimens had more than 1 nodal level of involvement. The sensitivity and negative predictive value of preoperative ultrasound to determine whether a specific nodal level was involved were: level 2: 54% and 66.2%; level 3: 47% and 49.4%; level 4: 60% and 55.4%; and level 5: 42% and 88.5%, respectively.
  
  
  CONCLUSIONS
  Patients undergoing lateral neck dissection after previous total thyroidectomy and RAI tend to have multiple involved nodes within multiple neck levels. Preoperative ultrasound is not sensitive enough to account for all of these involved nodes, therefore, a compartmental lateral neck dissection is recommended to minimize the risk of persistence and reoperation.
authors: Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors: Gaosong
authors: G
authors: Wu
authors: Shannon
authors: S
authors: Fraser
authors: Sara I
authors: SI
authors: Pai
authors: Tarik Y
authors: TY
authors: Farrag
authors: Paul W
authors: PW
authors: Ladenson
authors: Ralph P
authors: RP
authors: Tufano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D001918:Brachytherapy / Q000379:methods; D002277:Carcinoma / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D002291:Carcinoma, Papillary; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D012042:Registries; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D055815:Young Adult
chemical_list: D007457:Iodine Radioisotopes