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Background The primary purposes of this interdisciplinary consensus statement were to review the relevant indications for central neck dissection (CND) in patients with papillary thyroid cancer (PTC) and to outline the appropriate extent and relevant techniques required to accomplish a safe and effective CND. Methods A writing group convened by the American Head and Neck Society (AHNS) Endocrine Committee was tasked with identifying the important clinical elements to consider when managing the central neck compartment in patients with PTC based on available evidence in the literature, and the group's collective experience. The position statement paper was then submitted to the full Endocrine Committee, Education Committee, and AHNS Council. Results This consensus statement was developed to inform the clinical decision-making process when managing the central neck compartment in patients with PTC from the AHNS. This document is intended to provide clarity through definitions as well as a basic guideline from which to manage the central neck. It is our hope that this improves the quality and reduces variation in management of the central neck, facilitates communication, and furthers research for patients with thyroid cancer. Conclusion This represents, in our opinion, contemporary optimal surgical care for this patient population and is endorsed by the American Head and Neck Society. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

Objectives This study aimed to evaluate the significance of metastatic lymph node ratio (the ratio between the metastatic lymph node and the harvested lymph nodes; MLNR) in the central neck for the prediction of locoregional recurrence in patients with papillary thyroid microcarcinoma. Methods After reviewing medical records of papillary thyroid microcarcinoma patients who received total thyroidectomy with central neck node dissection, 573 consecutive adult patients were enrolled in this study, with a follow-up period of more than 36 months. Regarding the risk of recurrence, multivariate analyses were performed with the following variables; sex, age, multiplicity of the primary tumor, presence of pathological extrathyroidal extension, the level of postoperative stimulated serum thyroglobulin, the number of harvested lymph nodes, the number of lymph node metastasis and MLNR. Results The MLNR showed a predictive significance for the locoregional recurrence (P

Purpose The aim of this study was to compare reported results on available techniques for sentinel lymph node detection rate (SDR) in papillary thyroid cancer (PTC). Methods The MEDLINE database was searched via a PubMed interface to identify original articles regarding sentinel lymph node biopsy (SNB) in thyroid cancer. Studies were stratified according to the sentinel lymph node (SLN) detection technique: vital-dye (VD), Tc-nanocolloid planar lymphoscintigraphy with the use of intraoperative hand-held gamma probes (LS), both Tc-nanocolloid planar lymphoscintigraphy with intraoperative use of hand-held gamma probe and VD (LS + VD), Tc-nanocolloid planar lymphoscintigraphy with the additional contribution of preoperative SPECT/CT, and intraoperative use of hand-held gamma probe (LS-SPECT/CT). Pooled SDR values were presented with a 95% confidence interval (CI) for each SLN detection techniques. A Z-test was used to compare pooled SDR estimates. False-negative rates were summarized for each method. Results Forty-five studies were included. Overall SDRs for the VD, LS, LS + VD, and LS-SPECT/CT techniques were 83% (95% CI, 77%-88%; I = 78%), 96% (95% CI, 90%-98%; I = 68%), 87% (95% CI, 65%-96%; I = 75%), and 93% (95% CI, 86%-97%; I = 0%), respectively. False-negative rates were 0% to 38%, 0% to 40%, 0% to 17%, and 7% to 8%, respectively. Conclusions In patients with PTC, Tc-nanocolloids offer a higher SDR than that of the VD technique. The addition of SPECT/CT improved identification of metastatic SLNs outside the central neck compartment.

To delineate risk factors for, and examine temporal patterns of, histology-proven recurrent medullary thyroid cancer (MTC) after compartment-oriented surgery. Multivariate Cox regression on overall, node, and soft tissue infiltrate recurrence per previously dissected neck compartment. Mean follow-up for the 203 (and 158) patients with central (and ipsilateral lateral) neck dissection was 56.1 months. On multivariate Cox regression, tumor size > 20 mm predicted overall and node recurrence in the central neck, whereas extranodal growth predicted overall and node recurrence in the ipsilateral lateral neck. Extrathyroidal extension alone predicted soft tissue infiltrate recurrence in the central neck, and extranodal growth alone soft tissue infiltrate recurrence in the ipsilateral lateral neck. When analyses were restricted to patients not biochemically cured after initial surgery, only extranodal growth predicted overall and node recurrence in the dissected neck compartments. Patients not biochemically cured, specifically those with extranodal growth at the initial operation, carry greater risks of node recurrence.

Revision surgery of the central neck compartment is still a controversial subject, and data are scarce in the literature regarding surgical approaches and outcomes. This might be a result of the small number of patients in need of revision of the central neck compartment. Therefore, the purpose of this study was to document the approach and outcomes for revision surgery of the central neck compartment performed in our clinic. The files of patients who had undergone revision surgery of the central neck compartment in the Clinic of Otorhinolaryngology, Ankara Numune Training and Research Hospital, between 2007 and 2013, were evaluated. The subjects included 61 patients who had previously undergone surgical intervention in the central neck compartment and had then undergone bilateral lymph node dissection covering at least levels 6 and 7 in our clinic. Patient ages ranged between 36 and 63 years (mean, 47.2 y; SD = 8.3 y). The complications seen after revision surgery were temporary recurrent laryngeal nerve palsy in 4 patients (6.6%), temporary hypocalcemia in 8 patients (13.1%), and permanent hypocalcemia in 3 patients (4.9%). No permanent recurrent laryngeal nerve damage, wound infection, or hematoma was encountered. Meticulous surgical dissection with identification of the recurrent laryngeal nerve and the implantation site of the parathyroid glands may safeguard against complications. Reoperative surgery in the central compartment of the neck allows the removal of recurrent/persistent disease and has acceptable morbidity.

The presence of thyroid tissue in the mediastinum after total thyroidectomy is commonly known as “forgotten goiter,” which is considered as an extremely rare condition with controversy regarding the etiological causes. We report a 57-year-old female who has had a total thyroidectomy. Postoperatively, she underwent a computed tomography scan which revealed a retrosternal goiter. A reexploration was performed utilizing the previous collar incision. The mass was totally below the thoracic inlet separated from the central neck compartment. Forgotten goiter, though a rare pathology, can be prevented by meticulous preoperative imaging and can be managed during the first operation; however, surgical treatment for forgotten goiter, when performed in specialized centers, can be achieved through cervical approach and is associated with low morbidity.

Background We analyzed the incidence and the clinicopathological characteristics of papillary thyroid microcarcinoma (PTMC) in a high prevalence region of goiter with the purpose to investigate differences between incidental and nonincidental PTMC. Methods A total of 2236 patients who underwent total thyroidectomy from 2001 to 2009 were reviewed retrospectively. Papillary carcinoma was diagnosed in 583 patients. Of these, 339 patients with PTMC were included in the study. Clinicopathological features were evaluated by univariate and multivariate analysis. Results The prevalence of incidental PTMC was 12% of all patients who underwent surgery for thyroid disease. Univariate analysis showed that bilaterality (p = .001), autoimmune thyroid disease (p = .049), size of tumor >5 mm (p < .001), multifocality (p < .001), lymph node metastasis (p < .001), and capsule invasion (p < .001) were significantly associated with nonincidental PTMC. The incidence of lymph node metastasis in incidental PTMC was 5% versus 33% in nonincidental, suggesting that the biological behavior may be different in the 2 categories. Conclusion Our results indicate that a high rate of PTMC presented 1 or more risk factors including multifocality, bilaterality, capsule invasion, and lymph node metastasis. Therefore, we suggest total thyroidectomy followed by adequate exploration of the central neck compartment for possible nodal involvement and resection as a safe therapeutic approach. © 2013 Wiley Periodicals, Inc. Head Neck 36: 564–570, 2014

• Objective: To ascertain the extent to which pressure within a defined neck compartment could be used as predictor for wound healing. • Method: Thirty patients with various head and neck malignancies that were treated surgically, were considered prospectively. In the course of surgery a pressure microsensor was implanted into the defined neck compartment and data were collected over the first 48 hours postoperatively. logistic regression analysis was used to determine the strength of interfascial pressure (IP) as predictor for wound healing. • Results: Mean IP was 7.45 ± 6.15mmHg (95%Cl 7.13; 7.77). A logistic regression model relating good/disturbed healing outcome revealed that the mean pressure is the key variable, with a major influence on healing outcome. However, this type of model only explains approximately 46% of the total variation in the responses. This implies, that although pressure change contributes significantly in explaining variations in healing, there may be other significant predictors that were not included in the study. • Conclusion: This study demonstrates the feasibility of IP measurement in the neck, verifies it in a human clinical experiment and highlights its potential in the prediction of wound healing complications. The study seems to suggest that for high probability of good wound healing (> 90%) the IP values should be monitored and maintained below 7mmHg. At present, there are no comparator studies, as this kind of measurement in the neck area has not been reported yet. • Declaration of interest: This study received financial support from the Internal Grant Agency, ministry of Health of the czech republic (grant study no. NR8387). The author has no economic or social conflicts of interest to report.

Background. The role of routine prophylactic central-neck lymph node dissection (CLND) for papillary thyroid cancer (PTC) remains controversial. We perform CLND for PTC only in patients with enlarged nodes as determined by preoperative ultrasound and intraoperative inspection and palpation. Methods. We identified all patients with PTC who underwent CLND during thyroidectomy (group 1) at our institution, and then we identified an equivalent number of demographically matched patients who underwent thyroidectomy without CLND (group 2) and compared the outcomes of the 2 groups. Results. In all, 191 patients were identified for each group; 49/191 (26%) patients in group 1 developed locoregional nodal recurrence (12% central neck and 21 % lateral neck), compared with 11/191 (6%) patients in group 2 (3% central neck and 3% lateral neck; P < .05). Overall, 161/191 (84 %) patients in group 1 were disease free at last survey, compared with 180/191 (94%) patients in group 2 (P < .05). Transient hypocalcemia was significantly greater in group 1. No difference was found in disease-specific mortality. Conclusion. Surgeon assessment of the central neck compartment is an accurate predictor of which patients with PTC will benefit from CLND. Patients with nonenlarged central neck nodes who undergo total thyroidectomy without CLND have a low risk of developing recurrence.

Context: As a result of more sensitive techniques to detect recurrent thyroid cancer, the number of patients presenting with small, nonpalpable recurrent thyroid cancer in cervical lymph nodes is increasing. Surgical excision of nonpalpable recurrent thyroid cancer can be difficult, particularly in a previously operated area. Objective: The objective of this study was to investigate whether preoperative insertion of a hook needle under ultrasound guidance is useful in neck reoperations for recurrent thyroid cancer. Patients: Ten consecutive patients presenting over a 4-month period with nonpalpable, ultrasound-visible, fine needle biopsy-proven recurrent thyroid cancer in previously operated neck compartment(s) were studied. Main Outcome Measures: We measured whether it was technically possible to insert a hook needle preoperatively, rate of negative neck exploration, and complication rate. Results: The hook needle was inserted in seven patients. In three patients, the hook needle was not inserted; one patient had palpable disease 4 months after the preoperative clinic visit, one patient had a tumor too close to the carotid artery, and one patient had multiple bilateral foci of recurrent disease in the central neck. One patient had bleeding after insertion of the needle due to a penetration of an anterior jugular vein that was easily managed at neck reexploration. No other complication occurred during the hook needle insertion, and the only surgical complication was a transient recurrent nerve palsy. All pathology reports showed malignant disease. Conclusion: Hook needle-guided excision of recurrent thyroid cancer is feasible and appears to be a promising tool for safe and successful reoperation of patients with small recurrent thyroid cancer in cervical lymph nodes.

The importance of routine neck ultrasonography for the detection of unsuspected local or nodal recurrence of thyroid cancer following thyroidectomy (with or without neck dissection) is well documented in many journal articles and international guidelines. Herein, we present a pictorial summary of the sonographic features of benign and malignant central neck compartment nodules and cervical lymph nodes via a series of high-quality ultra-sonographic images, with a review of the literature.

The incidence of Well-differentiated Thyroid Carcinoma (WDTC) has been increasing over the past several decades. Consequently, so has the incidence of recurrence, which ranges from 15% to 30%. Factors leading to increased risk of recurrence are well described. However, the impact of local and regional recurrence is not well understood, but distant recurrence dramatically reduces 10-year survival to 50%. Recurrent WDTC has several established options for treatment; Observation, Radioactive Iodine (RAI), Surgery and External Beam Radiotherapy (EBRT). Novel treatments such as radiofrequency ablation (RFA) and percutaneous ultrasound-guided ethanol injection (PUEI) are beginning to gain popularity and have promising early results. A review of the current literature, outcome measurements and a strategy for revision surgery within the central neck compartment are discussed within this manuscript.

Objective: Recent American Thyroid Association (ATA) guidelines suggest a role for prophylactic central neck dissection in patients with papillary thyroid cancer (PTC). No studies directly address this subject in patients with the tall-cell-variant (TCV) of PTC. We sought to determine the risk of metastasis to the central compartment in patients with TCV.Method: A retrospective review was performed of all cases of papillary thyroid cancer undergoing primary surgical therapy with central neck dissection (CND) at our institution from 2007-2010. Charts were reviewed for demographic data, and pathology was reviewed for tumor histology, size, multi-focality, CND positivity, and extra-thyroidal extension (ETE).Results: A total of 63 patients with PTC underwent primary surgical therapy with CND, 10 of whom had TCV. Five of the TCV patients had positive nodes (50%), whereas only 18 of the 53 classical PTC had positive nodes (34%). TCV tumors were significantly larger than PTC tumors (1.8 cm 1.2 cm, P < .005). In ...

e17032 Background: The aim of this study was to determine frequency of lymphonodal metastases in jugulo-carotid chain (JCC) and central neck compartment in incidental thyroid microcarcinomas (ITMC)...

Purpose: To clarify the relationship between the pattern of cholecystolithiasis and the gross features of segmental adenomyomatosis of the gallbladder. Materials and Methods: Fifty-five consecutive patients with segmental adenomyomatosis with calcified gallbladder stones defined on CT were retrospectively analyzed in terms of (i) stone location (fundal vs. neck compartment) and (ii) size of the largest stone as a function of the extent of segmental mural thickening (type A, limited at the narrow segment; type B, partially extended in the fundal direction; type C, involving the entire fundal compartment). The extent of segmental mural thickening in patients with cholecystolithiasis was compared with a control group (n = 48) lacking stones. Results: Stones were found more frequently in the fundal compartment in 48 patients compared to the neck compartment in 12 patients (p