title: Metastatic papillary thyroid cancer with lateral neck disease: pattern of spread by level.
abstract: BACKGROUND
  Currently, there is no clear consensus on the extent of this lateral neck dissection required in papillary thyroid cancer (PTC) with lateral neck metastasis. The purpose of this study was to review our experience with metastatic PTC, and identify the pattern of lymphatic spread to the lateral neck.
  
  
  METHODS
  A retrospective medical chart review of PTC patients treated with lateral neck dissection (levels II-Vb) at our institution between January 2004 and 2011. A total of 185 patients underwent 248 selective lateral neck dissections.
  
  
  RESULTS
  Levels II, III, IV, and Vb were respectively involved in 49.3%, 76.6%, 61.6%, and 29.2% of cases.
  
  
  CONCLUSIONS
  We advocate for a routine excision of levels II, III, IV, and Vb in PTC with metastasize to any lateral neck level. Although we have routinely dissected level IIb, it may be appropriate to omit its dissection, as well as level Va, when there are no clinical, radiologic, or intraoperative evidence of disease involving these sublevels.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Mazin
authors.initials: M
authors.lastname: Merdad
authors.forename: Antoine
authors.initials: A
authors.lastname: Eskander
authors.forename: Teresa
authors.initials: T
authors.lastname: Kroeker
authors.forename: Jeremy L
authors.initials: JL
authors.lastname: Freeman
mesh_terms: D000328:Adult; D001707:Biopsy, Needle; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D002291:Carcinoma, Papillary; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery; D037981:Neck Dissection / Q000379:methods / Q000401:mortality; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D009367:Neoplasm Staging; D009864:Ontario; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology* / Q000556:secondary / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome