The American Thyroid Association Surgery Working Group with Participation from the American Association of Endocrine Surgeons, American Academy of Otolaryngology—Head and Neck Surgery, and American Head and Neck Society
Sally E. Carty,1,* David S. Cooper,2 Gerard M. Doherty,3 Quan-Yang Duh,4 Richard T. Kloos,5Susan J. Mandel,6 Gregory W. Randolph,7 Brendan C. Stack, Jr.,8 David L. Steward,9 David J. Terris,10 Geoffrey B. Thompson,11 Ralph P. Tufano,12 R. Michael Tuttle,13 and Robert Udelsman14
Background: The primary goals of this interdisciplinary consensus statement are to review the relevant anatomy of the central neck compartment, to identify the nodal subgroups within the central compartment commonly involved in thyroid cancer, and to define a consistent terminology relevant to the central compartment neck dissection.
Summary: The most commonly involved central lymph nodes in thyroid carcinoma are the prelaryngeal (Delphian), pretracheal, and the right and left paratracheal nodal basins. A central neck dissection includes comprehensive, compartment-oriented removal of the prelaryngeal and pretracheal nodes and at least one paratracheal lymph node basin. A designation should be made as to whether a unilateral or bilateral dissection is performed and on which side (left or right) in unilateral cases. Lymph node “plucking” or “berry picking” implies removal only of the clinically involved nodes rather than a complete nodal group within the compartment and is not recommended. A therapeutic central compartment neck dissection implies that nodal metastasis is apparent clinically (preoperatively or intraoperatively) or by imaging (clinically N1a). A prophylactic/elective central compartment dissection implies nodal metastasis is not detected clinically or by imaging (clinically N0).
Conclusion: Central neck dissection at a minimum should consist of removal of the prelaryngeal, pretracheal, and paratracheal lymph nodes. The description of a central neck dissection should include both the indication (therapeutic vs. prophylactic/elective) and the extent of the dissection (unilateral or bilateral).
*Authors are listed in alphabetical order.
1Department of Surgery, Section of Endocrine Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
2Division of Endocrinology and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
3Department of Surgery, University of Michigan Health Systems, Ann Arbor, Michigan.
4Surgical Services, Veterans Affairs Medical Center and University of California, San Francisco, California.
5Divisions of Endocrinology, Diabetes and Metabolism and Nuclear Medicine; Departments of Internal Medicine and Radiology; The Ohio State University, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, and The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
6Division of Endocrinology, Diabetes and Metabolism, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
7Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.
8Department of Otolaryngology—Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
9Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
10Department of Otolaryngology—Head and Neck Surgery, Medical College of Georgia, Augusta, Georgia.
11Mayo Clinic, Rochester, Minnesota.
12Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
13Department of Endocrinology, Memorial Sloan-Kettering Cancer Center, New York, New York.
14Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
Address correspondence to:
David L. Steward, M.D.
Department of Otolaryngology—Head and Neck Surgery
University of Cincinnati College of Medicine
231 Albert B. Sabin Way
Cincinnati, OH 45267-0528