الفهرس 
Introduction & Aim of WorkOnly 14 pages are availabe for public view
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Abstract
Differentiated thyroid carcinoma of the follicular epithelium is the most common endocrine cancer. Papillary thyroid cancer (PTC) is the most common type, representing about (75%) of all thyroid malignancies and more than (90%) of the differentiated types. Cervical lymph node metastases are very common in patients with papillary thyroid cancers. Despite the excellent prognosis, lymphatic spread is associated with increased risk of loco-regional recurrence, which significantly impairs quality of life and can alter prognosis of the patient. Therefore, the identification of lymph node metastases preoperatively is very important for the surgeon to plan the optimal surgical strategy for the patient.Lymphatic metastasis from PTC occurs in a step wise fashion: first to lymph nodes in the central neck compartment and subsequently to lymph nodes in the jagular chain including the supraclavicular fossa.Unfortunately, no clinical or pathological factors are able to predict with any certainty the presence of central nodal metastases. However, tumor size , some histological types, multifocality and locoregional infiltration can predict central nodal affection.Decisions regarding central lymphadenectomy in papillary thyroid carcinoma remain controversial. This is especially the case in patients presenting with no clinical evidence for lymph node metastases by physical examination or preoperative ultrasound. CNDs are preformed routinely with minimal morbidity in the hands of experienced surgeons. Although there is a current paucity of data demonstrating a clear decrease in recurrence for prophylactic CND, it should be considered in all patients presenting for treatment of papillary thyroid carcinoma. Perhaps an ipsilateral CND may be sufficient in patients with papillary microcarcinomas. The addition of central neck dissection to thyroidectomy is beneficial for achieving completeness of disease resection and can provide important information regarding tumor staging, thus facilitating postoperative management and long-term follow up. selective lateral neck dissection and modified radical neck dissections should be performed when there is clinical evidence of nodal disease in the lateral neck compartments. A wider use of immunocytochemical and genetic markers could be useful in improving the preoperative diagnosis, and the development of methods to aid the intraoperative identification of metastatic lymph nodes will certainly be useful in the near future for the improved selection of patients for prophylactic central neck dissection.