Peter Angelos and Jeffrey D Wayne Indications

The extent of lymph node dissection recommended for thyroid cancer is a controversial topic. Specifically, questions surround the optimal extent of lymph node dissection for well-differentiated thyroid cancer. There is no controversy about the need for an extensive lymph node dissection when dealing with medullary thyroid cancer. However, only approximately 10% of thyroid cancers are of the medullary type. For the more common and less biologically aggressive papillary and follicular thyroid cancers, the issue is how much of a neck dissection is enough. The choices in lymph node dissection vary from a minimalist node sampling operation to a classic radical neck dissection. Most authors agree that there is no need for a radical neck dissection because equally good local control and cure are readily obtained with less extensive operations. The modified radical neck dissection (or functional neck dissection) allows en bloc dissection of the lymphatic system in levels I through IV while preserving the sternocleidomastoid muscle, jugular veins, and/or spinal accessory nerve.

Neck dissection is indicated in patients with papillary and follicular thyroid cancers that have enlarged cervical lymph nodes where metastases are expected. Neck dissection is required for all patients with medullary thyroid carcinoma. The following operative approach may also be applied to patients with melanoma who have either clinically involved cervical lymph nodes upon presentation or, more commonly, who have a positive sentinel lymph node biopsy.

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