However, the ATA’s consensus statement on terminology of CLND differentially defines the innominate artery as the lower limit of a CLND. The American Thyroid Association (ATA) management guidelines on PTC specify a CLND to target the level VI. International guidelines used in PTC management inconsistently describe the inferior extent of CLND with sternal notch or the innominate vessel. The Chinese Thyroid Association (CTA) guidelines also recommend that patients with papillary thyroid carcinoma routinely undergo a central lymph node dissection to reduce the risk of long-term recurrence.Īlthough it is clear that CLND remains an integral strategy, whether this should include the level VII lymph node is not clear. At the same time, CN 0 papillary thyroid carcinoma patients with prophylactic central lymph node dissection can significantly improve the patient’s postoperative disease-free survival time and reduce the risk of recurrence. However, in recent years, a large number of clinical studies have found that the central lymph node metastasis rate of papillary thyroid carcinoma is higher. Ours is now performing routine prophylactic CLND.Īlthough according to the ATA guidelines, only high-risk cases require central lymphadenectomy. Given reasons of all above, the prophylactic CLND remains a strategy to treat PTC. Prophylactic central-compartment lymph node dissection (CLND) is important for disease staging, determining doses for radioactive iodine, and eliminating a source of recurrent disease. Ĭentral compartment lymph node metastasis is the most common due to its proximity to the thyroid. Lymph node dissection is critical in treating PTC, as these patients have high incidence of cervical lymph node metastasis (20~90%). Overall survival is considered excellent for most patients with PTC, exceeding 90% at 10 years. Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy, accounting for 85% of all thyroid carcinomas. In future, prognostic significance of level VII lymph node dissection should be evaluated through long-term surveillance. On the basis of surgery safety, transcervical level VII lymph node dissection could be considered for PTC patients with high risk factors such as ultrasonography-positive lymph nodes, tumor located in middle and lower thirds of the thyroid lobe and the patients without HT. Conclusionsīased on the results of our study, we considered central-compartment lymph node dissection (CLND) as an integral strategy. The multivariate logistic regression analysis showed ultrasonography-positive lymph nodes ( p < 0.001), the location of primary carcinoma ( p = 0.002) and hashimoto thyroiditis (HT) ( p = 0.04) were associated with level VII lymph node metastasis. Of the 275 subjects enrolled in this study, 79 patients (28.73%) showed lymph node metastasis to the level VII. Multivariate logistic regression analysis was performed to evaluate the associations between clinicopathologic factors. Patients with PTC were performed via video-assisted approach. Methodsīetween March 2015 and September 2016, a total of 275 consecutive patients were operated on for PTC with prophylactic level VII dissection at the Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, ZheJiang, China. The aim of this study was to identify clinicopathologic factors associated with level VII lymph node metastasis. The level VI lymph nodes are anatomically connected to the level VII lymph nodes and papillary thyroid carcinoma (PTC) can metastasis to both regions.
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