Management of cN_0 papillary thyroid carcinoma

Background and purpose:It is controversial to conduct cervical lymph node clearance for patients with clinically N0 papillary thyroid carcinoma.How and when lymph node clearance should be conducted is also not yet determined.This study evaluated the value of selective neck dissection for cN0 patients with papillary thyroid carcinoma(PTC).Methods:Between January 1,1999 and December 31,2006,we retrospectively studied 74 cN0 patients with identifi ed PTC who underwent ipsilateral thyroid lobectomy and selective neck dissection.Results:Ipsilateral thyroid lobectomy plus central neck dissection were performed in all patients and level Ⅵ metastasis was found in 43% of the patients(32/74).Selective neck dissection(levels Ⅱ-Ⅴ) was performed subsequently in these patients with level Ⅵ metastasis,and metastasis to the lateral neck lymph nodes subsequently accounted for 59%(19/32) of the patients.Central cervical lymph node metastases did not correlate with tumor size or the age of the patients.Lateral cervical lymph node metastases correlated with tumor size(χ2=5.96,P0.05),but also not correlated with the age of the patients.If there were two or more central lymph node metastasis,the number of metastatic central lymph nodes reached two or more,the metastatic rate of lateral cervical node was at 85.71%(χ2=4.61,P0.05).Conclusion:For cN0 patients with PTC,ipsilateral thyroid lobectomy as well as central neck dissection(level Ⅵ) is recommended.For the patients with level Ⅵ metastasis(n≥2),selective neck dissection(levels Ⅱ-Ⅴ) should be taken into consideration.