Determining the extent of lateral neck dissection necessary to establish regional disease control and avoid reoperation after previous total thyroidectomy and radioactive iodine for papillary thyroid cancer.

BACKGROUND The purpose of this study was to evaluate patients who underwent lateral neck dissection for fine-needle aspiration (FNA)-confirmed disease after total thyroidectomy and radioactive iodine (RAI) to determine the appropriate extent of resection necessary to avoid reoperation. METHODS This study was conducted with a retrospective review of medical charts of 100 consecutive patients. RESULTS Seventy-seven percent of initial lateral neck dissection specimens and 64% of reoperative lateral neck dissection specimens had more than 1 nodal level of involvement. The sensitivity and negative predictive value of preoperative ultrasound to determine whether a specific nodal level was involved were: level 2: 54% and 66.2%; level 3: 47% and 49.4%; level 4: 60% and 55.4%; and level 5: 42% and 88.5%, respectively. CONCLUSION Patients undergoing lateral neck dissection after previous total thyroidectomy and RAI tend to have multiple involved nodes within multiple neck levels. Preoperative ultrasound is not sensitive enough to account for all of these involved nodes, therefore, a compartmental lateral neck dissection is recommended to minimize the risk of persistence and reoperation.