Artículos de revistas
Skip metaskses in medullary thyroid carcinoma: A single-center experience
Fecha
2008Registro en:
SURGERY TODAY, v.38, n.6, p.499-504, 2008
0941-1291
10.1007/s00595-007-3664-8
Autor
TAVARES, Marcos R.
MICHALUART JR., Pedro
MONTENEGRO, Fabio
ARAP, Sergio
SODRE, Maria
TAKEDA, Flavio
BRANDAO, Lenine
TOLEDO, Sergio
FERRAZ, Alberto
Institución
Resumen
Purpose. Total thyroidectomy (TT) with level VI and VII central neck dissection is the initial treatment for medullary thyroid carcinoma (MTC) without identifiable neck metastasis. Level II to V lateral neck dissection is performed if neck metastasis is present or suspected. We conducted this study to identify the frequency and clinical determinants of skip neck metastasis in MTC. Methods. We reviewed the medical records of 32 patients who underwent TT and bilateral neck dissection for MTC. The clinical features were correlated with pN status in the central versus lateral compartments of the neck. Results. Neck lymph node metastasis (pN+) was found in 20 patients (62.5%) and skip metastases were found in 7 (35%) patients. The sensitivity of the pN status of the central compartment of the neck to predict the pN status of the lateral compartment of the neck was 53.8% and specificity was 63.2%. We found pN+ in 90% of the patients with lymph nodes > 15mm in diameter versus 50% in those with lymph nodes < 1.5mm in diameter. Conclusions. There is skip metastasis in MTC. It is unsafe to use the lymph node status of the central compartment of the neck to define the pN status of the lateral neck. A lymph node greater than 15 mm in diameter is related to pN status.