title: Incidence of metastases from 524 patients with papillary thyroid carcinoma in cervical lymph nodes posterior to the sternoclavicular joint (level VIa): Relevance for endoscopic thyroidectomy.
abstract: Dissection of central cervical lymph nodes posterior to the sternoclavicular joint is unsatisfactory in endoscopic thyroid surgery via remote access because of the barrier posed by the sternoclavicular joint. The purpose of this study was to determine the incidence and risk factors of papillary thyroid carcinoma (PTC) metastasis to the area posterior to the sternoclavicular joint.
  
  
  
  A total of 524 patients with PTC who underwent traditional thyroid surgery form January 2012 to December 2013 were analyzed retrospectively. Their cervical lymph nodes were harvested and divided into central cervical lymph nodes cranial to the sternoclavicular joint (VIb) and those nodes posterior to the sternoclavicular joint (VIa). The VIa status was correlated with clinicopathologic factors, including sex, age, clinical N classification, comorbid thyroid disease, tumor size, extrathyroidal extension, multifocality, tumor location, and central cervical lymph node metastasis.
  
  
  
  The VIa metastases were detected in 138 patients (26.3%; 138 of the 524). There were a mean 3.8 lymph nodes in VIa region, and the average number of metastatic lymph nodes was 0.5. Multivariate logistic regression revealed that cN1, extrathyroidal extension, VIb positivity, tumor size greater than 0.9 cm, and tumor location in the lower third of the thyroid lobe were factors associated with VIa metastasis.
  
  
  
  Patients undergoing PTC with tumor location in the lower third of the thyroid lobe, a tumor size greater than 0.9 cm, extrathyroidal extension, or cN1 may be contraindicated for an endoscopic thyroidectomy.
authors.affiliation: Department of Head and Neck Surgery, Institute of Micro-Invasive Surgery of Zhejiang University, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P. R. China.
authors.forename: Jianbiao
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Head and Neck Surgery, Institute of Micro-Invasive Surgery of Zhejiang University, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P. R. China.
authors.forename: Li
authors.initials: L
authors.lastname: Gao
authors.affiliation: Department of Head and Neck Surgery, Institute of Micro-Invasive Surgery of Zhejiang University, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P. R. China.
authors.forename: Chunyi
authors.initials: C
authors.lastname: Song
authors.affiliation: Department of Head and Neck Surgery, Institute of Micro-Invasive Surgery of Zhejiang University, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P. R. China. Electronic address: xiel@srrsh.com.
authors.forename: Lei
authors.initials: L
authors.lastname: Xie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000556:secondary* / Q000601:surgery*; D002291:Carcinoma, Papillary; D002648:Child; D004724:Endoscopy; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck; D009367:Neoplasm Staging; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D013247:Sternoclavicular Joint; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000556:secondary* / Q000601:surgery*; D013965:Thyroidectomy; D055815:Young Adult