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American Thyroid Association Consensus Review of the Anatomy, Terminology and Rationale for Lateral Neck Dissection in Differentiated Thyroid Cancer.

Background: Cervical lymph node metastases from differentiated thyroid cancer (DTC) are common. Thirty to eighty percent of patients with papillary thyroid cancer harbor lymph node metastases, with the central neck being the most common compartment involved. The goals of this study were to: 1) identify appropriate methods for determining metastatic DTC in the lateral neck and 2) address the extent of lymph node dissection for the lateral neck necessary to control nodal disease balanced against known risks of surgery. Methods: A literature review followed by formulation of a consensus statement by the Lateral Neck Subcommittee of the American Thyroid Association (ATA) Surgical Affairs Committee was performed. Results: Four proposals regarding management of the lateral neck are made for consideration in the next iteration of the ATA management guidelines for patients with thyroid nodules and differentiated thyroid cancer and any other future guideline proposals on DTC. Metastases to lateral neck nodes must be considered in the evaluation of the newly diagnosed thyroid cancer patient as well as for surveillance of the previously treated DTC patient. Conclusions: Lateral neck lymph nodes are a significant consideration in the surgical management of patients with DTC. When ATA guidelines are followed, initial evaluation of the DTC patient with ultrasound (or other modalities when indicated) will help to identify lateral neck lymph nodes of concern. These findings should be addressed using FNAB and a comprehensive neck dissection of at least nodal levels IIa, III, IV and Vb should be performed when indicated to optimize disease control.

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