Prophylactic Central Neck Dissection in 68 Patients with Lateral Compartment Metastases from Well Differentiated Thyroid Cancer

Abstract

Skip metastasis (SM) in Well Differentiated Thyroid Cancer (WDTC) patients are lateral neck lymph node metastasis that have skipped the central neck compartment. In these patients, prophylactic central neck dissection remains controversial.

We sought to identify clinicopathological factors associated with SM and determine the accuracy of central neck metastasis imaging in 68 patients at our institution over 16 years.

12 patients (17.6%) had SMs. Compared to the patients with occult central neck metastases, those with SM were more likely to have T1 tumors (p=0.005) and less likely to have extracapsular spread (p=0.032), thyroid capsule extension (p=0.003), soft tissue extension (p=0.006), and multifocal primary tumors (p=0.006).

In assessing the preoperative imaging, we compared central neck dissection pathology reports to the detection rates of CT and ultrasound. We found CT and ultrasound sensitivities of 31.8% and 45%, respectively and specificities of 80% and 85.7%, respectively.

WDTC patients with SM are more likely to have smaller, less aggressive primary tumors. However, the majority (82.4%) had central compartment disease and given the lack of sensitive preoperative imaging, we recommend prophylactic central neck dissections.

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