Lateral cervical lymph node metastases in papillary thyroid cancer: a systematic review of imaging-guided and prophylactic removal of the lateral compartment

Mubashir G. Mulla; Wolfram Trudo Knoefel; Jackie Gilbert; Alan McGregor; Klaus-Martin Schulte

doi:10.1111/j.1365-2265.2012.04336.x

Lateral cervical lymph node metastases in papillary thyroid cancer: a systematic review of imaging-guided and prophylactic removal of the lateral compartment

Mubashir G. Mulla^*, Wolfram Trudo Knoefel, Jackie Gilbert, Alan McGregor, Klaus-Martin Schulte

^*Corresponding author for this work

University of Düsseldorf

Research output: Contribution to journal › Article › peer-review

66 Citations (Scopus)

Abstract

Background
Papillary thyroid cancer (PTC) is a common endocrine cancer and frequently presents with lymph node (LN) metastases. The frequency of LN metastases in the lateral compartment and their surgical removal are poorly defined. There are no prospective randomised controlled trials addressing an eventual outcome difference relating to the extent of the initial surgical approach. The aim of this study was to define the extent of lateral LN involvement and the role of imaging in identification of these metastatic LN.

Design and Methods
A systematic review of studies of patients with PTC undergoing either prophylactic or therapeutic lymphadenectomy of the lateral cervical compartment. Studies involving imaging modalities in the detection of lateral cervical LNs in PTC were also analysed.

Results
Systematic review on the frequency of lateral LN metastases and their detection using various imaging tools identified 19 studies containing data on 5587 patients undergoing prophylactic or imaging-guided removal of the lateral compartment. Imaging-guided surgery retrieved cancerous lateral LNs in 446/3178 or 14% of eligible patients, whilst prophylactic lateral neck dissection yielded histopathological proof of cancer in 1177/204 or 57.5% of patients. The frequency of lateral compartment metastases increased with T stage. The sensitivity of ultrasound and CT was poor as low as 27% when accurately calculated.

Conclusion
Metastatic cervical LNs were found in more than half of patients when prophylactic lateral LN dissection was performed. Use of conventional imaging for the selection of the surgical approach to the lateral cervical compartment may commonly identify stage N1a instead of N1b and thus lead to false stage assignment as stage III rather than stage IV, concealing the severe prognostic implications of this stage progression in individual patients.

Original language	English
Pages (from-to)	126-131
Number of pages	6
Journal	Clinical endocrinology
Volume	77
Issue number	1
DOIs	https://doi.org/10.1111/j.1365-2265.2012.04336.x
Publication status	Published - Jul 2012

Keywords

NECK DISSECTION
PREOPERATIVE ULTRASONOGRAPHY
SURGICAL-MANAGEMENT
COMPUTED-TOMOGRAPHY
CARCINOMA PATIENTS
PROGNOSTIC-FACTORS
SAFE PROCEDURE
RISK-FACTORS
RECURRENCE
ULTRASOUND

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/j.1365-2265.2012.04336.x

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@article{12cb5a71d0ce4a428c2b8992f8f6a555,

title = "Lateral cervical lymph node metastases in papillary thyroid cancer: a systematic review of imaging-guided and prophylactic removal of the lateral compartment",

abstract = "Background Papillary thyroid cancer (PTC) is a common endocrine cancer and frequently presents with lymph node (LN) metastases. The frequency of LN metastases in the lateral compartment and their surgical removal are poorly defined. There are no prospective randomised controlled trials addressing an eventual outcome difference relating to the extent of the initial surgical approach. The aim of this study was to define the extent of lateral LN involvement and the role of imaging in identification of these metastatic LN. Design and Methods A systematic review of studies of patients with PTC undergoing either prophylactic or therapeutic lymphadenectomy of the lateral cervical compartment. Studies involving imaging modalities in the detection of lateral cervical LNs in PTC were also analysed. Results Systematic review on the frequency of lateral LN metastases and their detection using various imaging tools identified 19 studies containing data on 5587 patients undergoing prophylactic or imaging-guided removal of the lateral compartment. Imaging-guided surgery retrieved cancerous lateral LNs in 446/3178 or 14% of eligible patients, whilst prophylactic lateral neck dissection yielded histopathological proof of cancer in 1177/204 or 57.5% of patients. The frequency of lateral compartment metastases increased with T stage. The sensitivity of ultrasound and CT was poor as low as 27% when accurately calculated. Conclusion Metastatic cervical LNs were found in more than half of patients when prophylactic lateral LN dissection was performed. Use of conventional imaging for the selection of the surgical approach to the lateral cervical compartment may commonly identify stage N1a instead of N1b and thus lead to false stage assignment as stage III rather than stage IV, concealing the severe prognostic implications of this stage progression in individual patients.",

keywords = "NECK DISSECTION, PREOPERATIVE ULTRASONOGRAPHY, SURGICAL-MANAGEMENT, COMPUTED-TOMOGRAPHY, CARCINOMA PATIENTS, PROGNOSTIC-FACTORS, SAFE PROCEDURE, RISK-FACTORS, RECURRENCE, ULTRASOUND",

author = "Mulla, {Mubashir G.} and Knoefel, {Wolfram Trudo} and Jackie Gilbert and Alan McGregor and Klaus-Martin Schulte",

year = "2012",

month = jul,

doi = "10.1111/j.1365-2265.2012.04336.x",

language = "English",

volume = "77",

pages = "126--131",

journal = "Clinical endocrinology",

issn = "0300-0664",

publisher = "Wiley-Blackwell",

number = "1",

}

TY - JOUR

T1 - Lateral cervical lymph node metastases in papillary thyroid cancer

T2 - a systematic review of imaging-guided and prophylactic removal of the lateral compartment

AU - Mulla, Mubashir G.

AU - Knoefel, Wolfram Trudo

AU - Gilbert, Jackie

AU - McGregor, Alan

AU - Schulte, Klaus-Martin

PY - 2012/7

Y1 - 2012/7

N2 - Background Papillary thyroid cancer (PTC) is a common endocrine cancer and frequently presents with lymph node (LN) metastases. The frequency of LN metastases in the lateral compartment and their surgical removal are poorly defined. There are no prospective randomised controlled trials addressing an eventual outcome difference relating to the extent of the initial surgical approach. The aim of this study was to define the extent of lateral LN involvement and the role of imaging in identification of these metastatic LN. Design and Methods A systematic review of studies of patients with PTC undergoing either prophylactic or therapeutic lymphadenectomy of the lateral cervical compartment. Studies involving imaging modalities in the detection of lateral cervical LNs in PTC were also analysed. Results Systematic review on the frequency of lateral LN metastases and their detection using various imaging tools identified 19 studies containing data on 5587 patients undergoing prophylactic or imaging-guided removal of the lateral compartment. Imaging-guided surgery retrieved cancerous lateral LNs in 446/3178 or 14% of eligible patients, whilst prophylactic lateral neck dissection yielded histopathological proof of cancer in 1177/204 or 57.5% of patients. The frequency of lateral compartment metastases increased with T stage. The sensitivity of ultrasound and CT was poor as low as 27% when accurately calculated. Conclusion Metastatic cervical LNs were found in more than half of patients when prophylactic lateral LN dissection was performed. Use of conventional imaging for the selection of the surgical approach to the lateral cervical compartment may commonly identify stage N1a instead of N1b and thus lead to false stage assignment as stage III rather than stage IV, concealing the severe prognostic implications of this stage progression in individual patients.

AB - Background Papillary thyroid cancer (PTC) is a common endocrine cancer and frequently presents with lymph node (LN) metastases. The frequency of LN metastases in the lateral compartment and their surgical removal are poorly defined. There are no prospective randomised controlled trials addressing an eventual outcome difference relating to the extent of the initial surgical approach. The aim of this study was to define the extent of lateral LN involvement and the role of imaging in identification of these metastatic LN. Design and Methods A systematic review of studies of patients with PTC undergoing either prophylactic or therapeutic lymphadenectomy of the lateral cervical compartment. Studies involving imaging modalities in the detection of lateral cervical LNs in PTC were also analysed. Results Systematic review on the frequency of lateral LN metastases and their detection using various imaging tools identified 19 studies containing data on 5587 patients undergoing prophylactic or imaging-guided removal of the lateral compartment. Imaging-guided surgery retrieved cancerous lateral LNs in 446/3178 or 14% of eligible patients, whilst prophylactic lateral neck dissection yielded histopathological proof of cancer in 1177/204 or 57.5% of patients. The frequency of lateral compartment metastases increased with T stage. The sensitivity of ultrasound and CT was poor as low as 27% when accurately calculated. Conclusion Metastatic cervical LNs were found in more than half of patients when prophylactic lateral LN dissection was performed. Use of conventional imaging for the selection of the surgical approach to the lateral cervical compartment may commonly identify stage N1a instead of N1b and thus lead to false stage assignment as stage III rather than stage IV, concealing the severe prognostic implications of this stage progression in individual patients.

KW - NECK DISSECTION

KW - PREOPERATIVE ULTRASONOGRAPHY

KW - SURGICAL-MANAGEMENT

KW - COMPUTED-TOMOGRAPHY

KW - CARCINOMA PATIENTS

KW - PROGNOSTIC-FACTORS

KW - SAFE PROCEDURE

KW - RISK-FACTORS

KW - RECURRENCE

KW - ULTRASOUND

U2 - 10.1111/j.1365-2265.2012.04336.x

DO - 10.1111/j.1365-2265.2012.04336.x

M3 - Article

SN - 0300-0664

VL - 77

SP - 126

EP - 131

JO - Clinical endocrinology

JF - Clinical endocrinology

IS - 1

ER -

Lateral cervical lymph node metastases in papillary thyroid cancer: a systematic review of imaging-guided and prophylactic removal of the lateral compartment

Abstract

Keywords

UN SDGs

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