The second scenario is for patients without preoperative evidence of lymph node disease (cN0), but who present with lymph node microscopic metastasis in an intraoperative assessment, by a sentinel lymph node [17-20].
The aim of the present study is to identify the regional distribution pattern of PTC in order to recommend the optimal extension of lymphadenectomy levels when microscopic metastasis is present in these patients.
Follow-up imaging is also imperative, as microscopic metastasis
In the first patient (Patient 3, Table 1) the tumor responsible for a single right paratracheal lymph node microscopic metastasis
was suspected to be a synchronous right lobe subcentimeter (contralateral from the left sided noninvasive EFVPTC) classical papillary thyroid cancer.
(7-9) The identification of microscopic metastasis
in a sentinel lymph node has a significant impact on patient care; these patients are offered completion lymphadenectomy and stratified on the basis of node status for adjuvant therapy protocols.
In particular, the early detection of microscopic metastasis
will reduce the number of futile organ resections performed to prevent distant disease spread.
Immediate node removal's survival advantage became clear, however, if those patients who had immediate dissection and whose nodes were found to be positive for microscopic metastasis
were compared with patients who developed clinical adenopathy and then were dissected.