8-A837A-2017-Books-00129-029-060_Katz_Sec1_Ch02-ROUND-1

C H A P T E R 2 | Oncologic Components of Lymphadenectomy

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FIGURE 2-2  Level VI (A) and level VII (B) lymph node metastases on computed tomography imaging.

Therefore, adjunct cross-sectional imaging (typically contrast-enhanced computed tomography [CT]) can be helpful in analyzing the central compartment and superior mediastinal lymph node basins if there is suspicion of disease not readily visualized on ultrasonography (Fig. 2-2). 70–73 Gross inspection of the central neck compartment lymph tissue at the time of thyroidectomy should also be performed, given this ad- enopathy is readily encountered during the procedure. The most common site of lymph node metastasis in PTC is the central compart- ment. 74 Therapeutic surgical resection of involved lymph nodes with the use of compartment-oriented, en bloc resection of the lymph nodes in the involved com- partments provides the best treatment for cervical lymph node metastasis and is well established. 42,57,76–78 Macroscopic cervical lymph nodes cannot be adequately treated with radioactive iodine (RAI) therapy alone. Metastatic lymph nodes are the most common cause of persistent and recurrent PTC after initial treatment. 79–81 Persistent lymph node metastasis after thyroidectomy often occurs because of lack of or inac- curate preoperative imaging and subsequent omission of or incomplete lymphadenec- tomy in patients with clinically involved lymph nodes at the time of initial surgical