title: Intraoperative diagnosis of central compartment lymph node metastasis predicts recurrence of patients with papillary thyroid carcinoma and clinically node-negative lateral neck and may guide extent of initial surgery.
abstract: BACKGROUND
  Although lymph node (LN) metastasis (LNM) of papillary thyroid carcinoma (PTC) is common, routine prophylactic LN dissection (LND) is still controversial. The purpose of this study was to investigate risk factors for recurrence of PTC with clinically node-negative lateral neck to determine the utility of intraoperative LN biopsy.
  
  
  METHODS
  This study involved 185 patients with pathologically confirmed PTC and clinically node-negative lateral neck. All patients underwent thyroidectomy with or without ipsilateral or bilateral central LND after intraoperative central LN biopsy. Routine lateral neck LND was not performed. Clinicopathologic and intraoperative findings and post-treatment recurrences were recorded. Univariate and multivariate analyses with Cox-proportional hazards model were used to identify factors associated with recurrence.
  
  
  RESULTS
  During a follow-up of 50-96 months, six (3.2 %) patients had recurrences in lateral cervical LNs at a median 28 months (range 7-57 months) after surgery. Overall, 2- and 5-year RFS rates were 98.4 and 96.7 %, respectively. Univariate analyses revealed that tumor size (P = 0.005), bilaterality (P = 0.033), T4 disease (P < 0.001), and intraoperative diagnosis of central LNM (P = 0.001) were significantly predictive of recurrence. Multivariate analyses showed that T4 disease (P = 0.049) and intraoperative diagnosis of central LNM (P = 0.027) were independently predictive of recurrence.
  
  
  CONCLUSIONS
  Prophylactic lateral neck LND is not advocated for PTC with clinically node-negative lateral neck. Intraoperative LN biopsy may help identify patients at risk for recurrence and those who would benefit from LND.
authors.affiliation: Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
authors.forename: Chang Wook
authors.initials: CW
authors.lastname: Lee
authors.forename: Gyungyup
authors.initials: G
authors.lastname: Gong
authors.forename: Jong-Lyel
authors.initials: JL
authors.lastname: Roh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D002291:Carcinoma, Papillary / Q000473:pathology* / Q000601:surgery; D003657:Decision Making; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy; D055815:Young Adult