title: Anatomic Variability of the Upper Mediastinal Lymph Node Level VII.
abstract: Lymph node level VII, between the sternal notch and the innominate artery, is a frequent site of lymph node metastases in thyroid cancer. The objective of this study was to determine the cranial-caudal dimensions of level VII in patients undergoing central neck dissection for thyroid cancer and its accessibility through a neck incision only.
  
  
  
  Consecutive patients undergoing central neck dissection for thyroid cancer, with no previous neck dissection, mediastinal or thoracic surgery. The innominate artery was identified and the distance between the sternal notch and the upper border of the artery was measured to the nearest .5 mm. The sizes of level VII were compared with respect to age, sex, height, body mass index, type of neck dissection (therapeutic or prophylactic), and the incidence of previous thyroidectomy.
  
  
  
  One-hundred-one consecutive patients (65 women, 36 men, mean age 44 years (range 15-87) underwent prophylactic (n = 55) or therapeutic (n = 46) bilateral central compartment neck dissection. Level VII was accessible via the horizontal neck incision in all cases. Sizes of level VII ranged from 6 cm above the sternal notch to 35 mm below the sternal notch, with a mean distance of 3.5 mm below the sternal notch. The innominate artery was at the level of the sternal notch in 29 patients, and cranial to the sternal notch in 20 cases. No statistical relationship with age, sex, therapeutic/prophylactic neck dissection, previous surgery, body mass index or height was found.
  
  
  
  The maximal distance below the sternal notch was 35 mm. Level VII did not exist in 49 % of patients, and was less than 25 mm caudal to the sternal notch in 95 % of cases. Distinguishing level VII from level VI in thyroid cancer surgery may not be pertinent, due to the ease of access via a classic horizontal neck incision and the small sizes of level VII in the majority of patients.
authors.affiliation: Department of Head and Neck Oncology, Thyroid Surgery Unit, Institut de Cancérologie Gustave Roussy and Paris-Sud University, 114, Rue Edouard Vaillant, 94805, Villejuif Cedex, France. dana.hartl@gustaveroussy.fr.
authors.forename: Dana M
authors.initials: DM
authors.lastname: Hartl
authors.affiliation: Department of Head and Neck Oncology, Thyroid Surgery Unit, Institut de Cancérologie Gustave Roussy and Paris-Sud University, 114, Rue Edouard Vaillant, 94805, Villejuif Cedex, France.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Breuskin
authors.affiliation: Department of Head and Neck Oncology, Thyroid Surgery Unit, Institut de Cancérologie Gustave Roussy and Paris-Sud University, 114, Rue Edouard Vaillant, 94805, Villejuif Cedex, France.
authors.forename: Haïtham
authors.initials: H
authors.lastname: Mirghani
authors.affiliation: Department of Radiodiagnostics, Nuclear Medicine and Endocrine Oncology, Institut de Cancérologie Gustave Roussy and Paris-Sud University, 114, Rue Edouard Vaillant, 94805, Villejuif Cedex, France.
authors.forename: Amandine
authors.initials: A
authors.lastname: Berdelou
authors.affiliation: Department of Radiodiagnostics, Nuclear Medicine and Endocrine Oncology, Institut de Cancérologie Gustave Roussy and Paris-Sud University, 114, Rue Edouard Vaillant, 94805, Villejuif Cedex, France.
authors.forename: Désirée
authors.initials: D
authors.lastname: Déandréis
authors.affiliation: Department of Radiodiagnostics, Nuclear Medicine and Endocrine Oncology, Institut de Cancérologie Gustave Roussy and Paris-Sud University, 114, Rue Edouard Vaillant, 94805, Villejuif Cedex, France.
authors.forename: Edwige
authors.initials: E
authors.lastname: Pottier
authors.affiliation: Department of Biostatistics and Medical Economics, Center for Research in Epidemiology and Population Health, L'Institut National de la Santé et de la Recherche Médicale 1018, Institut de Cancérologie Gustave Roussy and Paris-Sud University, 114, Rue Edouard Vaillant, 94805, Villejuif Cedex, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Borget
authors.affiliation: Department of Radiodiagnostics, Nuclear Medicine and Endocrine Oncology, Institut de Cancérologie Gustave Roussy and Paris-Sud University, 114, Rue Edouard Vaillant, 94805, Villejuif Cedex, France.
authors.forename: Martin
authors.initials: M
authors.lastname: Schlumberger
authors.affiliation: Department of Radiodiagnostics, Nuclear Medicine and Endocrine Oncology, Institut de Cancérologie Gustave Roussy and Paris-Sud University, 114, Rue Edouard Vaillant, 94805, Villejuif Cedex, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Leboulleux
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059925:Anatomic Landmarks; D001158:Arteries / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum / Q000033:anatomy & histology*; D008875:Middle Aged; D009333:Neck / Q000033:anatomy & histology*; D037981:Neck Dissection; D010280:Parathyroid Glands / Q000473:pathology; D013249:Sternum; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy; D055815:Young Adult