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Peer-reviewedCC BY 4.0Otolaryngology--Head and Neck Surgery

Primary Tumor Location and Lymphatic Spread in Papillary Thyroid Carcinoma

  • Isabelle Fournier1
  • Mark E. Zafereo1
  • Sarah Hamidi2
  • Erich M. Sturgis3
  • Steven G. Waguespack2
  • Michelle D. Williams4
  • S. Mohsen Hosseini4
  • Mimi I. Hu2
  • Paul H. Graham5
  • Victoria Banuchi1
  • Neil D. Gross1
  • Miriam N. Lango1
12 more authors
  • Jennifer R. Wang1
  • Maria E. Cabanillas2
  • Naifa L. Busaidy2
  • Ramona Dadu2
  • Priyanka Iyer2
  • Steven I. Sherman2
  • Sachin K. Gupta1
  • Ryan P. Goepfert1
  • Elizabeth G. Grubbs5
  • Michael Kwon6
  • Salmaan Ahmed6
  • Anastasios Maniakas1
6 affiliations
  1. 1Department of Head & Neck Surgery The University of Texas MD Anderson Cancer Center Houston Texas USA
  2. 2Department of Endocrine Neoplasia and Hormonal Disorders The University of Texas MD Anderson Cancer Center Houston Texas USA
  3. 3Department of Otolaryngology–Head and Neck Surgery Baylor College of Medicine Houston Texas USA
  4. 4Department of Anatomical Pathology The University of Texas MD Anderson Cancer Center Houston Texas USA
  5. 5Department of Surgical Oncology The University of Texas MD Anderson Cancer Center Houston Texas USA
  6. 6Department of Neuroradiology The University of Texas MD Anderson Cancer Center Houston Texas USA
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Abstract

Objective: Papillary thyroid carcinoma (PTC) frequently metastasizes to cervical lymph nodes. Surgical planning is often based on the presumed central‐to‐lateral pattern of spread. The extent of central and lateral neck dissection remains controversial, with recommendations largely derived from small series. The study aimed to determine whether primary tumor location can guide the extent of neck dissection.

Study Design: Single‐center retrospective cohort study.

Setting: Quaternary care center.

Methods: Patients with PTC undergoing primary thyroid surgery with a central and/or lateral neck dissection (CND and/or LND) between 1999 and 2023 were evaluated. Tumor location (superior, mid, inferior pole, or isthmus) was determined by ultrasound and confirmed on pathology. The primary outcome was pattern of nodal metastases by tumor location.

Results: Among 1688 patients (median age 45 years; 67% female), 99% underwent CND and 45% LND. Central neck positivity was similar across superior (79%; 262/333), inferior (73%; 286/393), mid (74%; 626/849), and isthmic (76%; 71/94) tumors (P = .22). On multivariable logistic regression, central neck positivity did not differ significantly (superior OR: 1.28 [95% CI, 0.74‐2.23]; lower OR, 0.88 [95% CI, 0.52‐1.50]; mid OR, 0.79 [95% CI, 0.48‐1.32]; compared with isthmic. LND unadjusted and adjusted positivity rates were also comparable across primary tumor location. In patients undergoing LND, level III was most frequently involved (81%), followed by levels IV (75%), IIa (60%), Vb (36%), and IIb (9%) (P < .01). Lastly, superior pole tumors were significantly associated with ipsilateral level III involvement, compared with inferior and mid pole tumors (P < .01).

Conclusions: In patients undergoing therapeutic neck dissection for PTC, primary tumor location did not predict nodal distribution and should not determine the extent of neck dissection.

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Cite

BibTeXRIS
BibTeX
@article{fournier2026primary,
  title = {{Primary Tumor Location and Lymphatic Spread in Papillary Thyroid Carcinoma}},
  author = {Isabelle Fournier and Mark E. Zafereo and Sarah Hamidi and Erich M. Sturgis and Steven G. Waguespack and Michelle D. Williams and S. Mohsen Hosseini and Mimi I. Hu and Paul H. Graham and Victoria Banuchi and Neil D. Gross and Miriam N. Lango and Jennifer R. Wang and Maria E. Cabanillas and Naifa L. Busaidy and Ramona Dadu and Priyanka Iyer and Steven I. Sherman and Sachin K. Gupta and Ryan P. Goepfert and Elizabeth G. Grubbs and Michael Kwon and Salmaan Ahmed and Anastasios Maniakas},
  journal = {Otolaryngology--Head and Neck Surgery},
  year = {2026},
  month = oct,
  doi = {10.1002/ohn.70474},
  url = {https://doi.org/10.1002/ohn.70474},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Primary Tumor Location and Lymphatic Spread in Papillary Thyroid Carcinoma
AU  - Isabelle Fournier
AU  - Mark E. Zafereo
AU  - Sarah Hamidi
AU  - Erich M. Sturgis
AU  - Steven G. Waguespack
AU  - Michelle D. Williams
AU  - S. Mohsen Hosseini
AU  - Mimi I. Hu
AU  - Paul H. Graham
AU  - Victoria Banuchi
AU  - Neil D. Gross
AU  - Miriam N. Lango
AU  - Jennifer R. Wang
AU  - Maria E. Cabanillas
AU  - Naifa L. Busaidy
AU  - Ramona Dadu
AU  - Priyanka Iyer
AU  - Steven I. Sherman
AU  - Sachin K. Gupta
AU  - Ryan P. Goepfert
AU  - Elizabeth G. Grubbs
AU  - Michael Kwon
AU  - Salmaan Ahmed
AU  - Anastasios Maniakas
PY  - 2026
DA  - 2026/10/06
JO  - Otolaryngology--Head and Neck Surgery
DO  - 10.1002/ohn.70474
UR  - https://doi.org/10.1002/ohn.70474
AB  - Objective: Papillary thyroid carcinoma (PTC) frequently metastasizes to cervical lymph nodes. Surgical planning is often based on the presumed central‐to‐lateral pattern of spread. The extent of central and lateral neck dissection remains controversial, with recommendations largely derived from small series. The study aimed to determine whether primary tumor location can guide the extent of neck dissection.  Study Design: Single‐center retrospective cohort study.  Setting: Quaternary care center.  Methods: Patients with PTC undergoing primary thyroid surgery with a central and/or lateral neck dissection (CND and/or LND) between 1999 and 2023 were evaluated. Tumor location (superior, mid, inferior pole, or isthmus) was determined by ultrasound and confirmed on pathology. The primary outcome was pattern of nodal metastases by tumor location.  Results: Among 1688 patients (median age 45 years; 67% female), 99% underwent CND and 45% LND. Central neck positivity was similar across superior (79%; 262/333), inferior (73%; 286/393), mid (74%; 626/849), and isthmic (76%; 71/94) tumors (P = .22). On multivariable logistic regression, central neck positivity did not differ significantly (superior OR: 1.28 [95% CI, 0.74‐2.23]; lower OR, 0.88 [95% CI, 0.52‐1.50]; mid OR, 0.79 [95% CI, 0.48‐1.32]; compared with isthmic. LND unadjusted and adjusted positivity rates were also comparable across primary tumor location. In patients undergoing LND, level III was most frequently involved (81%), followed by levels IV (75%), IIa (60%), Vb (36%), and IIb (9%) (P < .01). Lastly, superior pole tumors were significantly associated with ipsilateral level III involvement, compared with inferior and mid pole tumors (P < .01).  Conclusions: In patients undergoing therapeutic neck dissection for PTC, primary tumor location did not predict nodal distribution and should not determine the extent of neck dissection.
SN  - 0194-5998
SN  - 1097-6817
ER  -