الفهرس 
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Abstract
Thyroid cancer is the most common endocrine malignancy and there have been a
steady increase in its incidence over the past 15-20 years. In Egypt, it represents
2.2% of total cancers. It constitutes 30% of endocrine malignancies and 12-49% of
head and neck tumors. Most of cases occur between 25 and 65 years of age but it
can also occur in very young and in elderly patients. Papillary thyroid cancer
(PTC) is the most common histologic subtype, accounting for about 80% of cases.
Cervical lymph node metastases in papillary thyroid cancer are frequent; occurring
in 30-80% of patients with the central compartment of the neck is the most
frequently involved. The management of the central compartment lymph nodes is
even less clear. There are multiple conflicting studies in this area.
The aim of this study is to evaluate the frequency and pattern of central neck
lymph node metastasis in papillary thyroid cancer and evaluation of its relation to
the lateral neck lymph node metastasis. This will assist us to find guidelines for
indications of the lateral neck dissection as it is not without morbidity. Also in this
study, we evaluated the complications of central neck dissection.
A total of 30 unselected patients suffering from papillary thyroid cancer were
treated in Menofia University from 2011 to 2013; all were treated for curative
intent. The study included 7 male and 23 female. The age ranged from 21 to 68
years old at initial treatment. All patients underwent good clinical examination and
neck ultrasound. All patients were diagnosed as papillary thyroid cancer by FNAC
or by frozen section biopsy during surgery.
Patients with non-papillary cancer, recurrent thyroid cancer and distant metastasis
were excluded from this study.
Summary
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All patients underwent total thyroidectomy and central lymph node dissection. The
central lymph node dissection was extended superiorly to the hyoid bone,
inferiorly to the innominate vein, laterally to the carotid sheaths, and dorsally to the
prevertebral fascia.
We defined the pretracheal, prelaryngeal (Delphian) and ipsilateral paratracheal
lymph nodes as ipsilateral central compartment, and contralateral pareatracheal
lymph nodes as contralateral central compartment.
The specimens were evaluated histopathologically with the thyroid gland. The
frequency and pattern of lymph node metastases in the central compartment were
analyzed and interpreted. Postoperative hypocalcaemia and recurrent laryngeal
nerve injury were also evaluated. The study demonstrated that 40% of patients
(12/30) have lymph node metastasis; the ipsilateral central compartment lymph
nodes are affected in all patients with metastatic lymphadenopathy (12/30). We
found that the contralateral central compatrment lymph nodes were involved in
four patients (13.33%). Isolated contralateral central compartment lymph node
metastasis was not found in our study. Also we found that 2 out of 12 central
lymph node positive patients have positive lateral neck lymph nod metastases.
In our study, 5/30 patients (16.7%) developed temporary hypocalcaemia, 2/30
patients (6.7%) developed permanent hypocalcaemia, and 2 patient (6.7%)
developed temporary vocal cord dysfunction.