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Indicators of Ohshima et al for Performing a Bilateral Modified Radical Neck Dissection in a Patient with a Papillary Thyroid Carcinoma

Description

Ohshima et al identified risk factors for bilateral metastases to regional lymph nodes in a patient with a papillary carcinoma of the thyroid gland. The presence of these factors can help identify a patient who may benefit from a bilateral modified radical neck dissection at the time of definitive initial surgery. The authors are from Noguchi Thyroid Clinic and Hospital Foundation in Beppu, Japan.


 

Parameters:

(1) gender

(2) size of the primary tumor

(3) involvement of the isthmus

(4) involvement of adjacent extrathyroid tissue

(5) gross nodal involvement at initial surgery

 

Parameter

Finding

Points

gender of the patient

female

0

 

male

1

size of the tumor

small to moderate (<= 20 mm)

0

 

large (> 20 mm)

1

involvement of the isthmus

absent

0

 

present

1

involvement of adjacent tissue

absent

0

 

present (with extracapsular adhesions or invasion )

1

gross nodal involvement

absent

0

 

present

1

 

number of risk factors =

= SUM(points for all 5 parameters)

 

Interpretation:

• minimum number of risk factors: 0

• maximum number of risk factors: 5

• The higher the number the higher one should consider performing a bilateral modified radical neck dissection. This may prevent the need for a second operation and may improve the patient's outcome.

• An older patient may be good candidate for bilateral neck dissection since they tend to do worse than younger patients if bilateral metastases should develop (page 1198). Looking at Figure 4 I would take this to mean anyone >= 40 years of age.

 


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