Terminology

Terminology

The literature contains variable terminology relevant to the central neck dissection. The following definitions are suggested for the purpose of consistent terminology usage within publications regarding the effectiveness and safety of the central neck dissection for thyroid cancer.

Therapeutic versus prophylactic/elective central neck dissection

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). The importance of this distinction when reporting results from studies cannot be overemphasized as the impact of clinically detectable nodal metastasis may differ from microscopic pathologic nodal metastasis. Prophylactic dissection is synonymous with elective dissection.

Describing the extent of central neck dissection

At a minimum, central compartment neck dissection should include the prelaryngeal, pretracheal, and at least one paratracheal lymph node basin. 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 synonymous with a selective compartment-oriented dissection. Isolated removal of only grossly involved lymph nodes violates the nodal compartment entered without adequately addressing its disease and may be associated with higher recurrence rates and morbidity from revision surgery (1).

A designation should be made as to whether a unilateral or bilateral paratracheal central neck dissection is performed and the operative record should indicate which side (right or left) in unilateral cases.

Central neck dissection, bilateral: Removal of the prelaryngeal, pretracheal, and both the right and left paratracheal nodal basins.

Central neck dissection, unilateral: Removal of the prelaryngeal, pretracheal, and one paratracheal nodal basin.

Central neck dissection may be extended to include comprehensive removal of additional nodal basins including the retropharyngeal, retroesophageal, paralaryngopharyngeal (superior vascular pedicle), and/or superior mediastinal (inferior to innominate artery). A designation should be made as to which additional nodal basins are included in the dissection.