title: American Thyroid Association consensus review and statement regarding the anatomy, terminology, and rationale for lateral neck dissection in differentiated thyroid cancer.
abstract: BACKGROUND
  Cervical lymph node metastases from differentiated thyroid cancer (DTC) are common. Thirty to eighty percent of patients with papillary thyroid cancer harbor lymph node metastases, with the central neck being the most common compartment involved. The goals of this study were to: (1) identify appropriate methods for determining metastatic DTC in the lateral neck and (2) address the extent of lymph node dissection for the lateral neck necessary to control nodal disease balanced against known risks of surgery.
  
  
  METHODS
  A literature review followed by formulation of a consensus statement was performed.
  
  
  RESULTS
  Four proposals regarding management of the lateral neck are made for consideration by organizations developing management guidelines for patients with thyroid nodules and DTC including the next iteration of management guidelines developed by the American Thyroid Association (ATA). Metastases to lateral neck nodes must be considered in the evaluation of the newly diagnosed thyroid cancer patient and for surveillance of the previously treated DTC patient.
  
  
  CONCLUSIONS
  Lateral neck lymph nodes are a significant consideration in the surgical management of patients with DTC. When current guidelines formulated by the ATA and by other international medical societies are followed, initial evaluation of the DTC patient with ultrasound (or other modalities when indicated) will help to identify lateral neck lymph nodes of concern. These findings should be addressed using fine-needle aspiration biopsy. A comprehensive neck dissection of at least nodal levels IIa, III, IV, and Vb should be performed when indicated to optimize disease control.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA. bstack@uams.edu
authors.forename: Brendan C
authors.initials: BC
authors.lastname: Stack
authors.forename: Robert L
authors.initials: RL
authors.lastname: Ferris
authors.forename: David
authors.initials: D
authors.lastname: Goldenberg
authors.forename: Megan
authors.initials: M
authors.lastname: Haymart
authors.forename: Ashok
authors.initials: A
authors.lastname: Shaha
authors.forename: Sheila
authors.initials: S
authors.lastname: Sheth
authors.forename: Julie Ann
authors.initials: JA
authors.lastname: Sosa
authors.forename: Ralph P
authors.initials: RP
authors.lastname: Tufano
mesh_terms: D001706:Biopsy / Q000379:methods; D044963:Biopsy, Fine-Needle; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D009333:Neck / Q000601:surgery; D037981:Neck Dissection / Q000379:methods / Q000592:standards*; D009362:Neoplasm Metastasis; D012955:Societies, Medical; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D014463:Ultrasonography; D014481:United States