Level V cervical lymph node involvement in patients with stage N1b papillary thyroid carcinoma: a prospective study

Objective The aim was to assess involvement of level V cervical lymph nodes (LNs) in patients with stage N1b papillary thyroid carcinoma (PTC) and to determine the clinical risks and benefits of routine level V dissection in these patients. Patients and methods The study included 20 patients with papillary thyroid cancer metastasizing to cervical LNs with no evidence clinically or radiologically of lymphadenopathy at level V. All cases were managed by total thyroidectomy and modified radical neck dissection. The study was conducted at the head, neck, and endocrine surgery unit at Main Alexandria University Hospital, Alexandria, Egypt. Results Metastatic LNs were distributed in the different cervical levels according to postoperative histopathology as follows: level II LNs were positive for malignancy in 16 neck sides (80%), level III in 17 neck sides (85%), and level IV in 15 neck sides (75%). Level VI LNs were positive in 19 patients (95%). Level V was free of malignancy in all studied patients. Postoperative complications were as follows: shoulder dysfunction was noted in three patients (15%), neck numbness and neuralgia were noted in seven patients (35%), recent hoarseness of voice was noted in one patient (5%), one patient (5%) showed delayed extubation, and ear numbness was noted in five patients (25%). No patients in our study experienced postoperative hematoma, chyle leak, or manifestations of hypoparathyroidism. Conclusions Incidence of cervical LN metastasis to level V in patients with N1b PTC is low compared with levels II, III, and IV. Moreover, there is clear evidence of postoperative morbidity from routine level V dissection in these patients. Therefore, level V dissection in patients with N1b PTC may be reserved for patients with clinically or radiologically evident level V metastasis.