title: Level I lymph node involvement in patients with N1b papillary thyroid carcinoma: a prospective study.
abstract: Most of the studies on the incidence, pattern, and predictive factors of lymph node (LN) metastasis with papillary thyroid carcinoma (PTC) have been performed retrospectively and no common consensus has been reached regarding the predictors for the involvement of level I LNs. This study was conducted prospectively to determine the incidence and the possible predictors of level I involvement in N1b PTC patients. The study included 30 consecutive patients with N1b stage of PTC. All the patients underwent neck dissection (ND) including level I. The relation between involvement of level I LNs and various clinicopathological variables was studied. Unilateral neck dissection was performed in 24 patients and bilateral neck dissection in six patients leading to 36 NDs. Level I was excised in all patients, with five specimens (14%) positive for metastasis. Levels II, III, IV, V, VI, and VII were positive in 52.8, 58.3, 58.3, 33.3, 63, and 22.2%, respectively. Level I involvement was significantly related to the number of lymph node levels affected (p = 0.003) and macroscopic extranodal invasion (p = 0.04). It was not related to the involvement of other individual levels, gender, age, size of the largest thyroid nodule, size of the largest LN involved, or histo-pathological variant of the tumor. This study suggests that including level I in therapeutic neck dissection for N1b PTC patients might be recommended in selected cases of multiple level involvement and macroscopic extranodal invasion requiring sacrifice of internal jugular vein, spinal accessory nerve, or sternomastoid muscle.
authors.affiliation: Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt. ahmad.eweida@bgu-ludwigshafen.de.|Department of Plastic and Reconstructive Surgery, University of Heidelberg, Heidelberg, Germany. ahmad.eweida@bgu-ludwigshafen.de.
authors.forename: Ahmad M
authors.initials: AM
authors.lastname: Eweida
authors.affiliation: Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
authors.forename: Mahmoud F
authors.initials: MF
authors.lastname: Sakr
authors.affiliation: Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
authors.forename: Yasser
authors.initials: Y
authors.lastname: Hamza
authors.affiliation: Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
authors.forename: Mohamed R
authors.initials: MR
authors.lastname: Khalil
authors.affiliation: Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
authors.forename: Essam
authors.initials: E
authors.lastname: Gabr
authors.affiliation: Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
authors.forename: Tarek
authors.initials: T
authors.lastname: Koraitim
authors.affiliation: Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
authors.forename: Hatem F
authors.initials: HF
authors.lastname: Al-Wagih
authors.affiliation: Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
authors.forename: Waleed
authors.initials: W
authors.lastname: Abo-Elwafa
authors.affiliation: Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.|Department of Endocrine Surgery, University College London, London, UK.
authors.forename: Tarek
authors.initials: T
authors.lastname: Ezzat Abdel-Aziz
authors.affiliation: Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Diab
authors.affiliation: Department of Pathology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
authors.forename: Basma
authors.initials: B
authors.lastname: El-Sabaa
authors.affiliation: Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
authors.forename: Aman S
authors.initials: AS
authors.lastname: Nabawi
mesh_terms: D000328:Adult; D002277:Carcinoma / Q000473:pathology / Q000601:surgery; D002291:Carcinoma, Papillary; D004534:Egypt / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery; D016606:Thyroid Nodule / Q000473:pathology*; D013965:Thyroidectomy / Q000379:methods*
keywords: Extranodal invasion; Level I; Lymph node metastases; Neck dissection; Papillary thyroid carcinoma