Cancer Therapy

Biography

Biography: Mahmoud F Sakr

Abstract

Objective: Th e aim of the present study was to determine the incidence of level I cervical lymph node (LN) involvement in patients with metastatic papillary thyroid carcinoma (PTC) and the possible indications of its dissection. Study Design: A prospective clinical study (case series) of 30 consecutive patients with N1b stage PTC, admitted to Alexandria Main University Hospital, and subjected to total thyroidectomy (TT) and neck dissection of all cervical LN levels.. Methods: In addition to demographics and clinical assessment, pre-operative thyroid function tests, cervical ultrasonography and computed tomography scan, and fi ne needle aspiration cytology were performed for all patients, and the fi nal histopathological examination was reviewed. Results: A total of 24 unilateral and 6 bilateral neck dissections were performed making a total of 36 neck dissections. Level I LNs was excised in all patients and proved positive for malignancy in fi ve (13.9%). Levels II, III, IV, V, VI and VII were positive in 52.8%, 58.3%, 58.3%, 33.3%, 63.9% and 22.2%, respectively. Level I involvement correlated signifi cantly with the number of LN levels aff ected (3 or more) (p=0.003) and extensive neck dissection (p=0.04). It was not related to any other single LN level involvement, gender, age, duration of symptoms, family of thyroid cancer, size of largest thyroid nodule, size of largest LN involved, or histopathological variant of the tumor. Conclusions: Th ough not uncommon in patient with PTC, level I cervical LN metastases are associated with multiple level involvement (3 or more) and invasion of the internal jugular vein, spinal accessory nerve or sternocleidomastoid muscle. A careful selection of patients requiring level I dissection is recommended to avoid an unjustifi ed added morbidity of the procedure. Key Words: Th yroid, papillary carcinoma, level I, lymph node, metastases, neck dissection