Factors Associated with Level II and V Involvement in Lateral Neck Dissection for pN1b Papillary Thyroid Carcinoma
4 affiliations
- 1General and Digestive Surgery Department, Baza Regional Hospital, Baza, 18800 Granada, Spain
- 2Endocrine Surgery Unit, General and Digestive Surgery Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain
- 3Department of Surgery, Faculty of Medicine, University of Granada, 18071 Granada, Spain
- 4Instituto de Investigación Biosanitaria ibs. GRANADA, 18012 Granada, Spain
Abstract
Background: Lateral neck dissection is the standard surgical treatment for patients with papillary thyroid carcinoma (PTC) and lateral cervical lymph node metastases (pN1b). However, the optimal extent of dissection remains debated, particularly for levels II and V. We examined patterns of nodal involvement and factors associated with metastases at these levels. Methods: This single-center retrospective study included 70 patients with pN1b PTC who underwent lateral neck dissection between 2019 and 2025. Demographic, clinical, surgical, and pathological variables were analyzed. The lymph node ratio (LNR), defined as metastatic nodes divided by harvested nodes, was dichotomized at the cohort median. Bivariate associations were assessed using Pearson’s χ2 test, Fisher’s exact test, or the Fisher–Freeman–Halton exact test, as appropriate; p < 0.05 indicated statistical significance. Results: Median age was 46 years and 60% were female. Involvement was highest at levels III (82.9%) and IV (65.7%), followed by II (55.7%) and V (23.9%). Median LNR was 0.25. Level II involvement was more frequent in male patients (71.4% vs. 45.2%; p = 0.031) and patients with high versus low LNR (76.5% vs. 36.1%; p = 0.001). Histological subtype was associated with level V involvement (p = 0.027), predominantly in classic PTC. Conclusions: Male sex and higher LNR were associated with level II involvement in bivariate analyses; an exploratory association was also observed between histological subtype and level V involvement. These findings do not establish independent predictors or justify altering the extent of neck dissection. Larger cohorts and multivariable analyses should validate these findings.
Related
- Multi-omics analysis of GBP2 as a prognostic and immune-associated biomarker in papillary thyroid carcinoma
- Modified supraclavicular approach for hemithyroidectomy with central neck dissection in unilateral papillary thyroid microcarcinoma: a feasibility-focused retrospective cohort study
- Long-term outcomes and prognostic factors in patients aged 70 years or older with early esophageal squamous cell carcinoma undergoing endoscopic submucosal dissection
- Ultrasound features for identifying cancer-associated fibroblasts expression in papillary thyroid carcinoma
- Potential involvement of a TLR4-associated CD155/TIGIT pathway in Porphyromonas gingivalis-induced immunosuppressive microenvironment formation in oral squamous cell carcinoma
BibTeX
@article{rios2026factors,
title = {{Factors Associated with Level II and V Involvement in Lateral Neck Dissection for pN1b Papillary Thyroid Carcinoma}},
author = {Patricia Díaz Ríos and Ana Belén Bustos Merlo and Juan Ignacio Arcelus Martínez and Antonio Becerra Massare and Nuria Victoria Muñoz Pérez and Jesús María Villar del Moral},
journal = {Cancers},
year = {2026},
month = oct,
doi = {10.3390/cancers18213473},
url = {https://www.mdpi.com/2072-6694/18/21/3473},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Factors Associated with Level II and V Involvement in Lateral Neck Dissection for pN1b Papillary Thyroid Carcinoma
AU - Patricia Díaz Ríos
AU - Ana Belén Bustos Merlo
AU - Juan Ignacio Arcelus Martínez
AU - Antonio Becerra Massare
AU - Nuria Victoria Muñoz Pérez
AU - Jesús María Villar del Moral
PY - 2026
DA - 2026/10/28
JO - Cancers
DO - 10.3390/cancers18213473
UR - https://www.mdpi.com/2072-6694/18/21/3473
AB - Background: Lateral neck dissection is the standard surgical treatment for patients with papillary thyroid carcinoma (PTC) and lateral cervical lymph node metastases (pN1b). However, the optimal extent of dissection remains debated, particularly for levels II and V. We examined patterns of nodal involvement and factors associated with metastases at these levels. Methods: This single-center retrospective study included 70 patients with pN1b PTC who underwent lateral neck dissection between 2019 and 2025. Demographic, clinical, surgical, and pathological variables were analyzed. The lymph node ratio (LNR), defined as metastatic nodes divided by harvested nodes, was dichotomized at the cohort median. Bivariate associations were assessed using Pearson’s χ2 test, Fisher’s exact test, or the Fisher–Freeman–Halton exact test, as appropriate; p < 0.05 indicated statistical significance. Results: Median age was 46 years and 60% were female. Involvement was highest at levels III (82.9%) and IV (65.7%), followed by II (55.7%) and V (23.9%). Median LNR was 0.25. Level II involvement was more frequent in male patients (71.4% vs. 45.2%; p = 0.031) and patients with high versus low LNR (76.5% vs. 36.1%; p = 0.001). Histological subtype was associated with level V involvement (p = 0.027), predominantly in classic PTC. Conclusions: Male sex and higher LNR were associated with level II involvement in bivariate analyses; an exploratory association was also observed between histological subtype and level V involvement. These findings do not establish independent predictors or justify altering the extent of neck dissection. Larger cohorts and multivariable analyses should validate these findings.
SN - 2072-6694
ER -