title: Mapping the distribution of nodal metastases in papillary thyroid carcinoma: Where exactly are the nodes?
abstract: To characterize nodal disease of patients presenting with papillary thyroid carcinoma (PTC) STUDY DESIGN: Retrospective chart review.
  
  
  
  PTC patients who underwent thyroidectomy and/or neck dissection (revision/primary) from 2004 to 2009 at a tertiary-care hospital were reviewed. Preoperative computed tomography (CT) scan and ultrasonography were utilized to identify macroscopic, clinically apparent nodal metastasis (cN+). Demographic data, type of surgery, nodal disease, and primary tumor information were recorded.
  
  
  
  Of 416 patients reviewed, 35% had cN+ on initial presentation (IP); of these, 88% and 50% had central (CND) and lateral nodal disease (LND), respectively. The presence of ectopic nodal (END) metastases (nodal disease outside typical CND or LND locations) was absent on IP but occurred in 9% of patients with nodal recurrence. END was typically found in the retropharyngeal area but also was noted in the sublingual region, subcutaneous location, axilla, and chest wall. Extrathyroidal extension (ETE) was found in 8.9% without nodal disease, 33.1% with nodal disease, and 57.1% with END (P < 0.0001). Primary tumor size greater than 4 cm (P = 0.05) was associated with nodal disease.
  
  
  
  This report represents a large series describing characteristics of the primary PTC tumor and associated nodal disease not only in the central and lateral neck but also in the ectopic locations. Our results suggest that a significant proportion of patients will have nodal disease in the central compartment on IP, especially younger patients. ETE and tumor size are associated with macroscopic nodal disease (including END). Nine percent of the patients with nodal recurrence had ectopic nodes occurring in various locations, most commonly in the retropharynx. CT scan can assist with identification and surgical planning of recurrent nodal disease.
  
  
  
  4. Laryngoscope, 127:1959-1964, 2017.
authors.affiliation: Division of Otolaryngology Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A.|Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A.|Division of Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Neerav
authors.initials: N
authors.lastname: Goyal
authors.affiliation: Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A.|Medicus Research, Agoura Hills, California, U.S.A.
authors.forename: Michael
authors.initials: M
authors.lastname: Pakdaman
authors.affiliation: Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Dipti
authors.initials: D
authors.lastname: Kamani
authors.affiliation: Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A.|Hallmark Health Medical Associates, Melrose-Wakefield Hospital, Melrose, Massachusetts, U.S.A.
authors.forename: Diana
authors.initials: D
authors.lastname: Caragacianu
authors.affiliation: Division of Otolaryngology Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A.
authors.forename: David
authors.initials: D
authors.lastname: Goldenberg
authors.affiliation: Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A.|Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Randolph
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000473:pathology* / Q000601:surgery; D002291:Carcinoma, Papillary; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D012189:Retrospective Studies; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy; D055815:Young Adult
keywords: PTC; central neck dissection; ectopic nodal metastasis; lateral neck dissection; nodal metastasis; recurrence