title: Predictors of level II and Vb neck disease in metastatic papillary thyroid cancer.
abstract: OBJECTIVE
  To identify predictors of levels II and Vb involvement in papillary thyroid cancer (PTC) with lateral neck metastasis.
  
  
  METHODS
  Large case series.
  
  
  METHODS
  High-volume tertiary care hospital.
  
  
  METHODS
  Consecutive sample of 185 patients who underwent 248 selective neck dissections of at least levels II to V for pathologically proven PTC.
  
  
  METHODS
  Significant independent predictors of level II and Vb metastasis, including age and pathologic variables (tumor diameter, dominant nodule cellular pathology, multifocality, extracapsular invasion, positive margins, and lymphovascular invasion).
  
  
  RESULTS
  Levels II and Vb were involved in 49.3% and 29.2% of our cohort, respectively. Age and lymphovascular invasion were independent predictors of level Vb involvement with metastasis (logistic regression: odds ratio for age = 0.92, SE = 0.03, P = .02; and odds ratio for lymphovascular invasion = 5.52, SE = 0.80, P = .03). No significant predictors were identified for level II involvement.
  
  
  CONCLUSIONS
  Levels II and Vb were involved in a significant number of patients with PTC and lateral neck disease. Younger age and lymphovascular involvement were independent risk factors for level Vb involvement in patients with PTC and lateral neck metastasis. The increased risk might be of marginal clinical significance. No significant predictors were identified for level II involvement. Our findings do not favor a limited neck dissection on the basis of any of the study's clinical or pathologic variables, and we therefore recommend the routine excision of levels IIa to Vb in all patients with PTC presenting with lateral neck disease.
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; D000368:Aged; D000704:Analysis of Variance; 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; D006801:Humans; D007150:Immunohistochemistry; D016015:Logistic Models; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009333:Neck / Q000473:pathology* / Q000601:surgery; D037981:Neck Dissection / Q000379:methods / Q000401:mortality*; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D062606:Tertiary Care Centers; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods